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Race-Free eGFR Equation IDs Kidney Failure, Mortality Risk

Among race-free equations, findings support using creatinine and cystatin C

WEDNESDAY, June 15, 2022 (HealthDay News) — Using an estimated glomerular filtration rate (eGFR) equation with creatinine (cr) and cystatin C (cys) may be preferable for assessing racial differences in the risk of mortality and kidney failure with replacement therapy (KFRT), according to a study published online June 6 in the Journal of the American Medical Association.

Orlando M. Gutiérrez, M.D., from University of Alabama at Birmingham, and colleagues assessed whether eGFR equations without race or cystatin C alter estimates of racial differences in risk of kidney failure requiring replacement therapy and mortality. Analysis included data from 62,011 participants from five general population and three chronic kidney disease U.S.-based cohorts (1988 to 2018).

The researchers found that over a mean follow-up of 13 years, decreased eGFR was associated with significantly greater risk of both outcomes for all equations. Comparing Black with non-Black participants, at an eGFR of 60 mL/min/1.73 m2, the hazard ratios for KFRT were 2.8 for eGFRcr with race, 3.0 for eGFRcys, and 2.8 for eGFRcr-cys versus 1.3 for eGFRcr without race. For Black versus non-Black participants, the five-year absolute risk differences for KFRT were 1.4 percent for eGFRcr with race, 1.1 percent for eGFRcys, and 1.3 percent for eGFRcr-cys versus 0.37 percent for eGFRcr without race. Analysis of mortality yielded similar patterns.

“Lessons learned from interrogating race essentialism within kidney function estimation must be applied across all aspects of medicine, including medical education and how race is considered in the development and application of clinical algorithms of disease risk,” write the authors of an accompanying editorial.

Several authors disclosed financial ties to the pharmaceutical industry.

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