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Kidney Week

Abstract: SA-PO038

Impact of Race-Free Estimated Glomerular Filtration Rate (eGFR) on Racial Disparity in Receiving Timely Outpatient Nephrology Care

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Fricker, Gabrielle E., Indiana University School of Medicine - West Lafayette, West Lafayette, Indiana, United States
  • Gunderman, David J., Indiana University School of Medicine - West Lafayette, West Lafayette, Indiana, United States
  • Kondury, Kasyap K., Indiana University School of Medicine - West Lafayette, West Lafayette, Indiana, United States
  • Moe, Sharon M., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Almakki, Akram, Indiana University School of Medicine - West Lafayette, West Lafayette, Indiana, United States
Background

In 2021, an international taskforce of kidney experts recommended implementation of a revised formula for estimated glomerular filtration rate (eGFR) that removes the race variable. Differences in eGFR and chronic kidney disease (CKD) stage have been reported for Black patients following implementation of the new CKD-EPI 2021 formula. However, the impact of the new equation on care and referral disparities is not well understood.

Methods

We conducted a retrospective cohort study of all adult patients referred to Indiana University Health outpatient nephrology clinics during a two-year period surrounding the change in eGFR formula. To analyze the impact of the new formula, we performed a multivariate linear regression with eGFR as the dependent variable, and sex, self-reported race, age, timeframe, BMI, and an interaction term between race and timeframe as covariates.

Results

812 patients met our criteria for analysis. Multivariate linear regression revealed that mean eGFR was statistically influenced by sex, race, age, and implementation of the new formula. Mean eGFR increased by 5.9 mL/min/1.73m2 (95% CI: 0.3, 11.4) for all patients after implementation of the new formula. However, the analysis revealed no evidence that the racial disparity in mean eGFR at the time of the first visit with nephrology was significantly influenced by the formula change (-3.7, 95% CI: -10.1, 2.7). Mean eGFR at the first visit was 6.7 mL/min/1.73m2 (95% CI: 2.4, 10.9) lower for Black patients compared to non-Black patients across the entire study period.

Conclusion

A general trend of increased mean eGFR across all patients after the equation change indicates earlier overall referrals to nephrology. Despite this improvement, our analysis did not reveal a significant change in the existing disparity in timely referral to nephrology observed between Black and non-Black patients. Black patients still had a lower mean eGFR at the initial visit to nephrology when compared to non-Black patients after implementation of the new eGFR formula, suggesting a persistent delay in referral to nephrology for Black patients.