The prevalence of chronic kidney disease among Black adults doubled when race adjustment was excluded from eGFR equations, according to a study.

This finding can implicate drug-dosing decisions and improve the accuracy of kidney failure prediction among higher-risk Black adults, according to Vishal Duggal, MD, a post-doctoral fellow in medical informatics at the Veterans Affairs Palo Alto Heath Care System, and colleagues. 

“Estimation of GFR without race adjustment reclassifies a sizeable fraction of Black adults with CKD. Because the race adjustment factor is constant and CKD prevalence is higher at earlier stages, its elimination leads to a larger effect on CKD prevalence at earlier vs. more advanced stages,” they wrote. 

Study methods

The researchers set out to uncover the implications on the prevalence of CKD and management strategies with the removal of race adjustment. This population-based study included cross-sectional and longitudinal data from adults in the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2016 and the Veterans Affairs Health Care System in 2015. Duggal and colleagues assessed the dosages of common medications impacted by kidney function and compared prognostic accuracy of the Kidney Failure Risk Equation with and without race adjustment of eGFR in the VA group. They compared this with the prevalence of CKD in the NHANES as a population sample. 

The study included participants with recorded outpatient serum creatinine measurements. Participants were characterized into Black or “non-Black” racial cohorts, according to the study. Researchers also recorded age, sex, height and weight of each participant in addition to diabetes status when provided. 

Findings 

Within the NHANES cohort, a weighted 10.9% of the U.S. population self-reported as Black, while the VA cohort included 784,337 Black veterans (17.5%).

The mean eGFR in the NHANES cohort was 96.3 mL/min per 1.73 m² with the original CKD-EPI equation and was 94.7 mL/min per 1.73 m² without race adjustment. Among Black participants in the NHANES cohort, the eGFR was 104.5 mL/min per 1.73 m² with the original CKD-EPI equation and was 90.2 mL/min per 1.73 m² without race adjustment. 

The mean eGFR in the VA cohort was 80 mL/min per 1.73 m² with the original CKD-EPI equation and was 78 mL/min per 1.73 m² without race adjustment. Among Black veterans, the eGFR was 87.3 with the original CKD-EPI equation and was 75.7 without race adjustment. Source: Healio

Show your support for high-impact kidney news

In these extraordinary times, millions rely on KidneyBuzz.com as an independent reporting platform that stands for truth and integrity. You’ve read multiple articles in the last year alone. With no shareholders or billionaire owner, we report on kidney events and breakthroughs with accuracy, free from political and commercial influence. And unlike many others, we’re committed to keeping our kidney-related journalism open for all readers. Every contribution, however big or small, makes a difference. Support us from as little as $1. Thank you.