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Abstract: TH-PO725

Black, Non-Hispanic Individuals Are More Likely to Have Slower eGFR Decline Before Dialysis

Session Information

Category: Diversity and Equity in Kidney Health

  • 800 Diversity and Equity in Kidney Health

Authors

  • Kraus, Michael A., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Wang, Yuedong, University of California System, Oakland, California, United States
  • Wang, Catherine Y., Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
  • Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Hahn Contino, Carly, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Kossmann, Robert J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Kaufman, Harvey W., Quest Diagnostics Inc, Secaucus, New Jersey, United States
Background

Race/ethnic inequities exist in ESRD care with regard to preemptive transplantation, ESRD primary access, and home therapies. Further, Blacks are >3x as likely and Hispanics and 1.3x more likely to have kidney failure versus Whites. Understanding pre-dialysis GFR decline may provide insights into the race disparity and aid in developing population-based tools. We report pre-dialysis eGFR decline using CKD-EPI 2021 equation without a race coefficient.

Methods

Patients initiated on dialysis at Fresenius Medical Care with matched clinical testing from Quest Diagnostics, 1/1/2015 - 9/30/2020 were included and deidentified. Inclusion criteria: a) 2 yrs of lab data prior to dialysis; b) >=10 serum creatinine (Scr) measurements; c) >= 1 Scr within 45 days of initiation; d) >= 2 Scr distributed over 2 quarters. Exclusion criteria were sudden eGFR increase > 20 mL/min/1.73 m2 or mean eGFR >30 mL/min/1.73 m2 within 45 days of dialysis. The revised CKD-EPI 2021 eGFR calculation was applied.

A cubic spline was fitted to eGFRs from each patient followed by functional data clustering methods to categorize eGFR trajectories. Both K-mean and functional principal component analysis were used. One-way ANOVA and χ2 tests were used to compare the trajectory groups for continuous and categorical variables.

Results

2341 patients: 42% female, age 64.9 +/-12.3 years, 62.7% White non-Hispanic, 15.7% Black non-Hispanic, and 15.0% Hispanic. Patients grouped into 4 clusters of eGFR progression velocity: 1076 stable low cluster (slc); 920 slow decay cluster (sdc); 285 fast decay cluster(fdc), and 60 in the very fast decay cluster (vfdc). eGFR decreases were steepest for the vfdc, followed sequentially by fdc, sdc, slc. Mean time from eGFR of 20 to dialysis was 669.5 days (94.8) for slc, 271.2 days (155.5) for sdc, 121.4 days (93.1) for fdc, and 75.2 days (61.8) for vfdc. Faster decay groups were younger*, male*, and Hispanic#. Black non-Hispanics were more likely to be in sdc than other clusters*, Whites, non-Hispanics were equally distributed through all 4 clusters. (* P<.001) (# P<.05)

Conclusion

AAs a group, Black, non-Hispanics were 1.3x more likely to display a slower pre-dialysis eGFR decline. This suggests that there is more time to allow for improved CKD care and education and potentially better outcomes in this group.

Funding

  • Commercial Support