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Kidney Week

Abstract: PO2319

Comparing Estimated Glomerular Filtration Rates (eGFR) for US Black Veterans with and Without the Black-Race Coefficient and Normalization to a Fixed Body Surface Area (BSA)

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Bragg-Gresham, Jennifer L., University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Morgenstern, Hal, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
  • Shahinian, Vahakn, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Chu, Chi D., University of California San Francisco, San Francisco, California, United States
  • Powe, Neil R., University of California San Francisco, San Francisco, California, United States
  • Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Zivin, Kara, Veterans Health Administration, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan Medical School, Ann Arbor, Michigan, United States
Background

The CKD-EPI estimation of GFR includes two corrections: 1) increasing eGFR for Blacks by 15.9% to more accurately reflect measured GFR; 2) normalizing eGFR in all races to a fixed value (1.73 m2) of BSA to compare across populations. We aimed to assess the impact of removing both corrections—separately and together—on the prevalence of CKD in Black US Veterans.

Methods

Among 7 million Black US Veterans, aged 18+ with at least one serum creatinine lab measurement (2006-2018), we estimated the prevalence of eGFR < 60, using four GFR-correction methods: 1) eGFR using the CKD-EPI equation with the Black-race coefficient and normalized to a BSA of 1.73 m2; 2) #1, without the Black-race coefficient; 3) #1, without normalization for BSA; and 4) #1, without the Black-race coefficient or normalization for BSA.

Results

Among Black Veterans, the average age was 57 years, 87% males, and average BSA was 2.11 m2. The prevalence of CKD varied appreciably by the method of GFR estimation. CKD prevalence was highest (15-20%) throughout the 13-year study period without use of the Black-race coefficient (#2) and lowest (6-8%) without normalization for BSA (#3). The method with neither the Black-race multiplier nor BSA normalization (#4) yielded similar estimates of CKD prevalence as the CKD-EPI method of eGFR estimation (#1), differing by <2% throughout the study period. Patient-level agreement between the latter two methods was nearly 80%.

Conclusion

Our results show good agreement between Black Veterans classified as having CKD using the CKD-EPI equation with both corrections and those same veterans classified with CKD without either correction. Pending recommendations from the NKF-ASN Task Force, the latter method (#4) offers a simplified procedure to provide individualized GFR estimates on the original scale (mL/min) for all individuals.

Funding

  • Other U.S. Government Support