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Kidney Week

Abstract: PO2317

Impact of Removing the Race Coefficient from Estimation of Glomerular Filtration Rate (eGFR) at the University of Washington

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Carias Zuniga, Sandra G., University of Washington School of Medicine, Seattle, Washington, United States
  • Mehrotra, Rajnish, University of Washington School of Medicine, Seattle, Washington, United States
  • Young, Bessie A., University of Washington School of Medicine, Seattle, Washington, United States
  • Bansal, Nisha, University of Washington School of Medicine, Seattle, Washington, United States
Background

The inclusion of the race coefficient in eGFR estimates for patients identified as Black has been widely debated. In response, our institution eliminated the race coefficient when reporting eGFR on June 1, 2020. We evaluated changes in prescription of metformin, dialysis initiation and referral to subspecialists among Black and non-Black patients before vs. after the change in eGFR reporting.

Methods

We manually reviewed data of self-identified Black patients with CKD within the UW system between June through November of 2019 (before change in eGFR reporting) and 2020 (after change in eGFR reporting). In addition, data from the electronic medical record (EMR) was extracted for subspecialty referral rates for Black and non-Black patients during this same time frame. We compared 6-month data pre/post change of eGFR and determined differences in: initiation and discontinuation of metformin, indication for and mean eGFR at dialysis initiation, and new referrals to nephrology, transplant and vascular surgery.

Results

After the change in eGFR reporting, rates of metformin initiation increased (4/223 in 2020 vs. 0/219 in 2019), while discontinuation rates were stable (18% in 2019 vs. 15% in 2020) among Black patients with CKD. Rates of dialysis initiation were comparable (2.7% in 2020 vs. 1.4% in 2019, mean eGFR 8 vs. 13 ml/min/1.73m2) in Black patients with CKD, with the primary indication of uremic symptoms remaining unchanged. Comparing Black vs. non-Black patients, subspecialty referral rates for nephrology and transplant nephrology were higher for Blacks after the change in eGFR reporting (Figure 1).

Conclusion

After removing the race coefficient from eGFR reporting, patterns of medication prescription rates and dialysis initiation did not substantially change, however subspecialty referral rates increased for Black patients with CKD. We acknowledge that the COVID-19 pandemic may have impacted these trends, but the trends overall are encouraging for improving health outcomes and nephrology access to care for Black patients with CKD.