Removing race from the CKD-EPI equation and its impact on prognosis in a predominantly White European population. Issue 1 (11th June 2022)

• Record Type: Journal Article
• Authors: Fu, Edouard L; Coresh, Josef; Grams, Morgan E; Clase, Catherine M; Elinder, Carl-Gustaf; Paik, Julie; Ramspek, Chava L; Inker, Lesley A; Levey, Andrew S; Dekker, Friedo W; Carrero, Juan J
• Is Part Of: Nephrology dialysis transplantation. Volume 38:Issue 1(2023)
• Page Start: 119
• Page End: 128
• Publication Date: 2022-06-11
• Subjects: CKD-EPI -- creatinine -- epidemiology -- glomerular filtration rate -- kidney diseases; Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfac197
• Languages: English
• ISSNs: 0931-0509

Abstract

ABSTRACT: Background: While American nephrology societies recommend using the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation without a Black race coefficient, it is unknown how this would impact disease distribution, prognosis and kidney failure risk prediction in predominantly White non-US populations. Methods: We studied 1.6 million Stockholm adults with serum/plasma creatinine measurements between 2007 and 2019. We calculated changes in eGFR and reclassification across KDIGO GFR categories when changing from the 2009 to 2021 CKD-EPI equation; estimated associations between eGFR and the clinical outcomes kidney failure with replacement therapy (KFRT), (cardiovascular) mortality and major adverse cardiovascular events using Cox regression; and investigated prognostic accuracy (discrimination and calibration) of both equations within the Kidney Failure Risk Equation. Results: Compared with the 2009 equation, the 2021 equation yielded a higher eGFR by a median [interquartile range (IQR)] of 3.9 (2.9–4.8) mL/min/1.73 m 2, which was larger at older age and for men. Consequently, 9.9% of the total population and 36.2% of the population with CKD G3a–G5 was reclassified to a higher eGFR category. Reclassified individuals exhibited a lower risk of KFRT, but higher risks of all-cause/cardiovascular death and major adverse cardiovascular events, compared with non-reclassified participants of similar eGFR. eGFR by both equations strongly predicted study outcomes, with equal discrimination and calibration for the Kidney Failure Risk Equation. Conclusions: Implementing the 2021 CKD-EPI equation in predominantly White European populations would raise eGFR by a modest amount (larger at older age and in men) and shift a major proportion of CKD patients to a higher eGFR category. eGFR by both equations strongly predicted outcomes.