Abstract: TH-OR66
How Removing the Race Coefficient from eGFR Equations Impacts Racial Differences in CKD Progression Among People with HIV
Session Information
- Preventing Progression and Reassessing Race in GFR Estimation
November 04, 2021 | Location: Simulive, Virtual Only
Abstract Time: 04:30 PM - 06:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Muiru, Anthony N., University of California San Francisco, San Francisco, California, United States
- Madden, Erin, Northern California Institute for Research and Education, San Francisco, California, United States
- Shlipak, Michael, University of California San Francisco, San Francisco, California, United States
- Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States
Group or Team Name
- NA-ACCORD
Background
The impact of removing the race coefficient from eGFR equations on racial differences in CKD progression in people with HIV (PWH) is unknown.
Methods
We included 69,125 PWH enrolled in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) from Jan 1, 2005-Dec 31,2014. Baseline date was defined as the date of enrollment in NA-ACCORD or beginning of cohort eGFR observation window, whichever came last. Reported race was categorized as Black, White, or Other. We defined CKD stages in 2 ways: 1) Serum creatinine-based CKD-EPI eGFR equation, which assigns higher eGFR for Black persons; and 2) CKD-EPI eGFR without the race coefficient. We created Markov models to estimate 5-year probabilities of transitioning from the initial stage to worse CKD stages, with death as a competing event; the associations of race (Black vs White) with progression across CKD stages were evaluated.
Results
31,298 PWH were Black, in whom baseline antiretroviral use and HIV suppression were less prevalent and hepatitis C infection, hypertension and diabetes were more prevalent compared with White participants (N=27,542). eGFR without the race coefficient reclassified 25% of Black PWH into a worse CKD stage at baseline. Those reclassified had a higher prevalence of CKD risk factors compared with Black PWH who were not reclassified. When modeled with the race coefficient, Black PWH had 23% lower risk of progressing from CKD stage 1 to 2, similar risk of progressing from stage 2 to 3 and 3-fold increased risk of progressing from stage 3 to 4, compared with White PWH. When CKD progression was modeled using race-free eGFR, Black PWH consistently had a higher risk of CKD progression compared with White PWH (Table).
Conclusion
Prior studies suggesting that Black PWH have lower risk than White individuals for early CKD progression but higher risk at later stages were likely biased by the race coefficient. Assigning higher kidney function for all Black individuals based on race systematically masks a subgroup of Black PWH who are at higher risk of CKD progression.
| CKD progression | With Race Coefficient Hazard Ratio (95% CI) | Without Race Coefficient Hazard Ratio (95% CI) |
| Stage 1 to 2 | 0.77 (0.73,0.82) | 1.26 (1.20,1.33) |
| Stage 2 to 3 | 0.99 (0.92,1.07) | 1.08 (1.01,1.16) |
| Stage 3 to 4 | 2.93 (2.50,3.44) | 1.61 (1.38,1.88) |
| Hazard ratio adjusted for calendar period (2005-2009 and 2010-2015), age, sex, History of AIDS, Hepatitis C, Diabetes, Hypertension, Cardiovascular disease, baseline viral load, and baseline eGFR. | ||
Funding
- NIDDK Support