1. < Kidney & Bladder

Race and chronic kidney disease

Posted by ptw @ptw, Jun 27 3:24pm

I am concerned about the effects of the new race neutral estimation of kidney function (GFR) and treatment eligibility. It is estimated that ten non-Black patients who probably have chronic kidney disease (CKD) are projected to lose CKD treatment opportunities for every one Black patient who probably does not have CKD granted expanded opportunities (J Am Soc Nephrology 2023, 34:309).

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Moderator
Colleen Young, Connect Director | @colleenyoung | Jun 27 6:20pm

Here is the link to the 2023 publication
- National Projections for Clinical Implications of Race-Free Creatinine-Based GFR Estimating Equations https://pubmed.ncbi.nlm.nih.gov/36368777/

And the 2022 publication (full text)
- National Projections for Clinical Implications of Race-Free Creatinine-Based GFR Estimating Equations https://pmc.ncbi.nlm.nih.gov/articles/PMC10103103/

The conclusion states:
Conclusion: The newly recommended 2021 CKD-EPI creatinine-based eGFR equation may result in substantial changes to recommended care for US patients of all racial and ethnic groups.

Whenever guidelines change, it can be destabilizing. @ptw, do you have chronic kidney disease? Have the new guidelines resulted in any changes to your care?

REPLY
ptw | @ptw | Jun 28 8:26am

I am a retired research scientist who has been concerned about the patient care under the revised race-neutral calculation of glomerular filtration rate (GFR). I've written several papers on this topic, but they are probably inaccessible to the patient population that is most in need of this information. Patient CKD treatment opportunities are strongly guided by their GFR. The statistically impartial GFR estimate and the politically correct GFR estimate can be found on the internet. Patients' physician or nephrologist probably have little choice in which formula the use because of the behind-the-seen efforts by the ASN/NKF to convince clinical laboratories to provide only the politically correct version (the race neutral 2021 CKD-EPI formula). In fact, patients may actually have less severe CKD than they've been told if they are Black and more severe CKD than they've been told if they are not Black. I believe that patients should at least be aware of this issue in discussion of your treatment options with their physician and nephrologist.

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Moderator
Colleen Young, Connect Director | @colleenyoung | Jun 28 1:26pm
In reply to @ptw "I am a retired research scientist who has been concerned about the patient care under the..." + (show)
@ptw

I am a retired research scientist who has been concerned about the patient care under the revised race-neutral calculation of glomerular filtration rate (GFR). I've written several papers on this topic, but they are probably inaccessible to the patient population that is most in need of this information. Patient CKD treatment opportunities are strongly guided by their GFR. The statistically impartial GFR estimate and the politically correct GFR estimate can be found on the internet. Patients' physician or nephrologist probably have little choice in which formula the use because of the behind-the-seen efforts by the ASN/NKF to convince clinical laboratories to provide only the politically correct version (the race neutral 2021 CKD-EPI formula). In fact, patients may actually have less severe CKD than they've been told if they are Black and more severe CKD than they've been told if they are not Black. I believe that patients should at least be aware of this issue in discussion of your treatment options with their physician and nephrologist.

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@ptw, I noticed that you wished to post a useful URL to an article with your post. You will be able to add URLs to your posts in a few days. There is a brief period where new members can't post links. We do this to deter spammers and keep the community safe. Clearly the link you wanted to post is not spam.

Here are 3 links, explaining eGFR calculators, the current and the previous calculators.

- NIH eGFR Calculators https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/kidney-disease/laboratory-evaluation/estimated-gfr-calculators
- eGFR Calculators for Adults & Pediatrics https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/kidney-disease/laboratory-evaluation/estimated-gfr-calculators/adults-pediatrics
- Previous eGFR Calculator for Reference https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/kidney-disease/laboratory-evaluation/estimated-gfr-calculators/previous

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