Limited Evidence for Use of a Black Race Modifier in eGFR Calculations: A Systematic Review.

Lauren R Cirrincione, Mark A Marzinke, Dina N Greene, Patrick M Bossuyt, Allison B Chambliss, Christopher R McCudden, Stacy E F Melanson, Jaime H Noguez, Khushbu Patel, Asa E Radix, Yemisi Takwoingi, Gabrielle Winston-McPherson, Bessie A Young, Melanie P Hoenig

Journal: Clinical chemistry 2022;68(4):521-533

PMID: 34927677

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Abstract

BACKGROUND

Commonly used estimated glomerular filtration rate (eGFR) equations include a Black race modifier (BRM) that was incorporated during equation derivation. Race is a social construct, and a poorly characterized variable that is applied inconsistently in clinical settings. The BRM results in higher eGFR for any creatinine concentration, implying fundamental differences in creatinine production or excretion in Black individuals compared to other populations. Equations without inclusion of the BRM have the potential to detect kidney disease earlier in patients at the greatest risk of chronic kidney disease (CKD), but also has the potential to over-diagnose CKD or impact downstream clinical interventions. The purpose of this study was to use an evidence-based approach to systematically evaluate the literature relevant to the performance of the eGFR equations with and without the BRM and to examine the clinical impact of the use or removal.

CONTENT

PubMed and Embase databases were searched for studies comparing measured GFR to eGFR in racially diverse adult populations using the Modification of Diet in Renal Disease or the 2009-Chronic Kidney Disease Epidemiology Collaboration-creatinine equations based on standardized creatinine measurements. Additionally, we searched for studies comparing clinical use of eGFR calculated with and without the BRM. Here, 8632 unique publications were identified; an additional 3 studies were added post hoc. In total, 96 studies were subjected to further analysis and 44 studies were used to make a final assessment.

SUMMARY

There is limited published evidence to support the use of a BRM in eGFR equations.

Address: Departments of Pathology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA.; Deptartment of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.; Department of Pathology, University of Southern California, Los Angeles, CA.; Department of Pharmacy, University of Washington, Seattle, WA.; Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada.; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.; Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH.; Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA.; Callen-Lorde Community Health Center, New York, NY.; Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham and NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.; Department of Medicine, New York University School of Medicine, New York, NY.; Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI.; Office of Healthcare Equity, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.; Department of Medicine, Renal Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

DOI: 10.1093/clinchem/hvab279