Removing race from CKD-EPI will calculate lower eGFR for Black patients and exclude more from receiving chemo
WEDNESDAY, Sept. 1, 2021 (HealthDay News) — Removing race from the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation will calculate a lower estimated glomerular filtration rate (eGFR) for Black patients and exclude more from receiving chemotherapy, according to a study published online Aug. 13 in The Lancet Oncology.
Morgan A. Casal, Pharm.D., from the School of Pharmacy at the University of Pittsburgh, and colleagues conducted a retrospective analysis of patients enrolled in phase 1 studies sponsored by the Cancer Therapy Evaluation Program between January 1995 and October 2010. The CKD-EPI equation and a version of the CKD-EPI without the race term (CKD-EPIwithout race) were used to calculate eGFR based on creatinine (eGFRcr). The Cockcroft-Gault equation was used to calculate estimated creatinine clearance (eClcr). For 10 anticancer drugs, dosing simulations based on each assessment of kidney function were conducted.
Demographic and laboratory values were included from 340 Black patients. The researchers found that the median eGFRcr was 103 mL/min and 89 mL/min calculated by CKD-EPI and CKD-EPIwithout race, respectively, and the eClcr was 90 mL/min by Cockcroft-Gault. Compared with the CKD-EPI, the number of patients ineligible for therapy or recommended to receive any renal dose adjustment was increased when CKD-EPIwithout race was used, but was at a similar rate when Cockcroft-Gault was used. Using CKD-EPIwithout race versus CKD-EPI, up to 18 percent of patients had discordant recommendations.
“Exclusion of the race term from the CKD-EPI equation could paradoxically worsen care for Black patients with cancer,” the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
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