Kidney Week

Abstract: TH-PO729

2021 CKD-EPI: Unintended Consequences in Living Kidney Donation

Session Information

• Diversity and Equity in Kidney Health - I
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 800 Diversity and Equity in Kidney Health

Authors

• Kumar, Vineeta, University of Alabama at Birmingham Bone Marrow Transplant Program, Birmingham, Alabama, United States

Vineeta Kumar,

• Orandi, Babak J., University of Alabama at Birmingham Bone Marrow Transplant Program, Birmingham, Alabama, United States

Babak J. Orandi,

• Reed, Rhiannon D., University of Alabama at Birmingham Bone Marrow Transplant Program, Birmingham, Alabama, United States

Rhiannon D. Reed,

• Maclennan, Paul A., University of Alabama at Birmingham Bone Marrow Transplant Program, Birmingham, Alabama, United States

Paul A. Maclennan,

• Shelton, Brittany A., University of Alabama at Birmingham Bone Marrow Transplant Program, Birmingham, Alabama, United States

Brittany A. Shelton,

• Mcleod, Marshall Chandler, University of Alabama at Birmingham Bone Marrow Transplant Program, Birmingham, Alabama, United States

Marshall Chandler Mcleod,

• Locke, Jayme E., University of Alabama at Birmingham Bone Marrow Transplant Program, Birmingham, Alabama, United States

Jayme E. Locke,

Group or Team Name

• University of Alabama at Birmingham, Comprehensive Transplant Institute

Background

Chronic Kidney Disease (CKD) Epidemiology Collaboration eGFR formula (2021 CKD-EPI) removed Black race from the 2009 equation, with the goal of not disproportionately affecting one racial group. Unintended consequences may lead to reclassifying potential Black living kidney donors (LKD) as having more advanced CKD, potentially exacerbating living donation disparities

Methods

Using national data, we identified LKD with pre-donation eGFR>60 ml/min/1.73m² consistent with living donor screening guidelines to quantify the CKD stage reclassification based on eGFR for Black LKD

Results

Among 63,246 LKD, 11.2% (n=6,365) were Black with a mean creatinine of 0.88 mg/dl. Black LKD eGFR was 109.7 ml/min/1.73m² using the 2009 formula and 97.7 ml/min/1.73m² using the 2021 formula. Overall, 17.7% of Black LKD were reclassified as having a higher CKD stage pre-donation with the 2021 formula. (Fig.1)

Among 44,525 LKD with >2 creatinine measurements post-donation, 9.3% (n=4,149) were Black with a mean creatinine of 1.24 mg/dl. Black LKD mean eGFR was 73.2 ml/min using the 2009 formula and 65.6 ml/min/1.73m² using the 2021 formula. Overall, 25.5% of Black LKD were reclassified as having a higher CKD stage post-donation with the 2021 formula. (Fig.1)

Conclusion

While eGFR formulas were not developed for use in LKD, many centers use eGFR in screening and most use eGFR in post donation follow up. Exclusion of race in the formula may inappropriately label potential LKD with CKD thus exacerbate existing racial disparities. Post donation label of CKD may cause undue distress to LKD and health care consequences. These data highlight the need for a validated eGFR formula for LKD, use of measured and not eGFR & education of non-transplant care teams regarding interpretation of CKD staging in LKD.

Funding

• NIDDK Support