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Kidney Week

Abstract: TH-OR63

Decline in Estimated Glomerular Filtration Rate (eGFR) Among Black Veterans After Removing the Race Coefficient: Results of the US Veterans Health Administration Electronic Health Records

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Yan, Guofen, University of Virginia School of Medicine, Charlottesville, Virginia, United States
  • Norris, Keith C., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Scialla, Julia J., University of Virginia School of Medicine, Charlottesville, Virginia, United States
  • Hu, Nan, Florida International University, Miami, Florida, United States
  • Yu, Wei, University of Virginia School of Medicine, Charlottesville, Virginia, United States
  • Greene, Tom, University of Utah Health, Salt Lake City, Utah, United States
  • Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States
Background

In the US, Black Americans with CKD have faster kidney function decline than White peers. We examined whether this faster decline was also observed when the race coefficient was removed from eGFR calculation among US veterans.

Methods

eGFRs were calculated from serum creatinine measurements (excluding acute care settings) using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) and the CKD-EPI without the race coefficient (CKD-EPI-RACEout). We estimated eGFR slopes using quarterly averages of eGFRs for up to 8 years or until May 31, 2018 starting from the first quarter after CKD incidence (i.e., first eGFR<60 mL/min/1.73m2 for >3 months). We used linear mixed-effects models with random intercept and slope, adjusting for age, sex, eGFR at CKD incidence, and CKD incidence year.

Results

From 2003-2017, 139,921 Black veterans had incident CKD defined by CKD-EPI-RACEout and 100,510 by CKD-EPI; and 636,598 White veterans by CKD-EPI, with median number of quarterly averages of eGFRs per patient of 8, 8, and 7, respectively. Overall, eGFR decline was greater among Blacks defined by CKD-EPI than Whites (-1.37 vs -0.84 mL/min/1.73m2 per year, Table), consistent with prior findings. eGFR decline among Blacks by CKD-EPI-RACEout was attenuated (-1.07), but still greater than among Whites. In the two youngest groups, Blacks by CKD-EPI-RACEout still had about 2-fold larger decline versus Whites (Table).

Conclusion

Black veterans with CKD defined by eGFR without race coefficient still had faster kidney function decline following CKD incidence compared to White veterans, but the difference was attenuated. Use of eGFR without race coefficient may pick up earlier, less aggressive cases of CKD among younger Blacks and promote earlier prevention.

Slopes as eGFR decline per year (95% CI) with CKD-EPI with and without race coefficient
 Black,
eGFR defined by CKD-EPI
Black, eGFR defined by CKD-EPI without race coefficientWhite
Overall-1.37 (-1.40, -1.35)-1.07 (-1.09, -1.06)-0.84 (-0.85, -0.83)
Age 18-45-2.45 (-2.66, -2.25)-1.26 (-1.38, -1.15)-0.59 (-0.74, -0.45)
Age 46-55-1.92 (-1.99, -1.85)-1.16 (-1.20, -1.11)-0.60 (-0.64, -0.55)
Age 56-65-1.47 (-1.52, -1.44)-1.10 (-1.13, -1.07)-0.73 (-0.75, -0.71)
Age 66-75-1.18 (-1.21, -1.14)-1.04 (-1.07, -1.00)-0.84 (-0.86, -0.83)
Age 76-85-0.97 (-1.01, -0.92)-0.92 (-0.96, -0.87)-0.93 (-0.94, -0.91)
Age 86-100-0.82 (-0.94, -0.71)-0.82 (-0.95, -0.67)-1.00 (-1.04, -0.97)

Funding

  • NIDDK Support