Racial Disparities and Chronic Kidney disease

eGFR (estimated glomerular filtration rate) is a crucial step in measuring CKD (chronic kidney disease). It makes the interpretation of renal indicators, such as cystatin C and creatinine, easier. According to a survey conducted by the College of American Pathologists (CAP), approximately 89% of laboratories report eGFR in addition to serum creatinine. On the other hand, there are issues with the accuracy of eGFR measurements among black populations. According to studies, the eGFR equations now in use may overestimate GFR in Black Americans, which could result in an underdiagnosis of CKD (blog).

Efforts to improve its accuracy include examining the transferability of equations to Black individuals who are not Americans. The goal of adding a race component to eGFR equations is to account for unidentified variables that could raise baseline serum creatinine; nonetheless, this highlights how artificial race is simply a societal construct. For drug administration, nephrology referrals, and clinical trial eligibility, precision in eGFR measurement is essential. However, there remain issues with equations that use cystatin C (Uppal et al.). The inability of race classification to be correlated with underlying genetic/metabolic differences and the difficulties associated with multiracial identity are among its shortcomings.

Research has shown that Black individuals excrete creatinine at higher rates, which is why a racial coefficient was added to eGFR calculations. This modification, which raises eGFR by roughly 18% and 16% in the MDRD and CKD-EPI equations, respectively, is predicated on the idea that Black individuals have larger average muscle mass, a claim for which there is inconclusive evidence and which may be influenced by socioeconomic circumstances (Uppal et al.). It's crucial to remember that the generalization about Black individuals having more muscle mass is incorrect because muscle mass can only be precisely quantified in cadavers rather than in living people. The inclusion of the race coefficient ignores social variables that could influence variations in creatinine levels among racial groups, as well as other significant CKD predictors like diabetes and hypertension.

The UCDH Working Group is advocating for a change in eGFR reporting by removing the race parameter, which would result in a single eGFR value in patient charts. It is anticipated that this modification will improve the sensitivity of CKD detection and is consistent with national initiatives to address CKD inequities, specifically in African American communities. The group stresses the need to avoid perpetuating racial stereotypes while acknowledging the variation in creatinine-based eGFR among people. For circumstances requiring greater precision, recommendations for other GFR measurements, such as renal clearance or cystatin C, are given (“Filtering Bias out of Kidney Testing - Penn Medicine”). Based on total clinical status rather than a single eGFR measurement, this approach gives clinicians flexibility in therapy beginning, transplant recommendations, and clinical trial eligibility.

Works Cited

blog, Laboratory Best Practice. “Race and EGFR: Addressing Health Disparities in Chronic Kidney Disease.” Lab-Best-Practice, 29 Apr. 2021, health.ucdavis.edu/blog/lab-best-practice/race-and-egfr-addressing-health-disparities-inchronic-kidney-disease/2021/04.

“Filtering Bias out of Kidney Testing - Penn Medicine.” Www.pennmedicine.org, www.pennmedicine.org/news/publications-and-special-projects/penn-medicine-magazine /winter-2021/filtering-bias-out-of-kidney-testing#:~:text=The%20researchers%20propose d%20that%20the.

Uppal, Prabhdeep, et al. “The Case against Race-Based GFR.” Delaware Journal of Public Health, vol. 8, no. 3, 1 Aug. 2022, pp. 86–89, www.ncbi.nlm.nih.gov/pmc/articles/PMC9495470/, https://doi.org/10.32481/djph.2022.08.014.