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Abstract: ASN Annual Meeting 2020 -- Digital Meeting |
Gama R, Clery A, Palmer KR, et al.
Estimated Glomerular Filtration Rate Equations: Do We Need to Use the Ethnicity Correction Factor in People of African Ancestry Outside of the United States?
ASN Annual Meeting 2020 -- Digital Meeting
J Am Soc Nephrol (Oct) 31:19A 2020
BACKGROUND
Recent African studies suggest ethnicity factors in estimated glomerular filtration rate (eGFR) equations is not required.
METHODS
To assess accuracy of eGFR equations, with and without ethnicity factors compared with gold standard 51Cr-ethylenediaminetetraacetic acid (51Cr-EDTA) clearance assays. Patients with albumin <30g/dl, hepatology referrals, <18 years old, non-white or black, mixed ethnicities were excluded. Accuracy of CKD-EPI and MDRD equations compared to 51Cr-EDTA GFR were assessed with and without correction factor.
RESULTS
2,776 51Cr-EDTA studies were identified (Mean age-54yrs; 43% female; 12% Black ethnicity). In Black patients, CKD-EPI and MDRD eGFR equations significantly overestimated GFR compared to White (p<0.001) but without ethnicity correction factor estimates were considerably improved (p<0.001)(Table 1). Accuracy was superior for GFR≥60ml/min/1.73m2 compared to <60ml/min/1.73m2 using CKD-EPI equation for both White and Black patients (p<0.001).
CONCLUSION
Overestimation of measured GFR with eGFR equations using ethnicity correction factors identified in this study may lead to reduced rates of CKD diagnosis and under -recognition of CKD severity in people of Black ethnicity in the UK. These findings require prospective validation in other countries.
TABLE 1: ESTIMATED GLOMERULAR FILTRATION EQUATIONS BIAS, PRECISION AND ACCURACY COMPARED WITH 51CR-EDTA CLEARANCE FOR PEOPLE OF BLACK AND WHITE ETHNICITIES ACCORDING TO 51CR-EDTA GFR CATEGORIES
GFR Mean (SD) Bias Precision Limits of agreement 30% Accuracy (%) Black Corrected 51Cr- EDTA
GFR <60
(N=56)Corrected 51EDTA 41.0 (13.8) CKD-EPI adjusted 59.4 (27.3) 18.4 19.8 -21.2 to 58 39.3 CKD-EPI unadjusted 51.2 (23.6) 10.2 16.7 -23.2 to 43.6 55.4 MDRD adjusted 57.2 (24.8) 16.2 17.5 -18.8 to 51.2 48.2 MDRD unadjusted 47.2 (20.5) 6.2 14.1 -22.0 to 34.4 64.3 Corrected 51Cr-EDTA ≥GFR 60
(N=249)Corrected 51EDTA 87.2 (16.0) CKD-EPI adjusted 107.9 (22.3) 20.7 21.9 -23.1 to 64.5 59.4 CKD-EPI unadjusted 93.1 (19.3) 5.9 19.7 -33.5 to 45.3 81.1 MDRD adjusted 107.3 (30.2) 20.1 28.1 -36.1 to 76.3 59.4 MDRD unadjusted 88.5 (24.9) 1.3 23.7 -46.1 to 48.7 77.5 White Corrected 51Cr- EDTA
GFR <60
(N=399)Corrected 51EDTA 46.6 (11.2) CKD- EPI 64.2 (21.2) 17.6 16.1 -14.6 to 49.8 44.1 MDRD 61.4 (21.6) 14.8 17.1 -19.4 to 49.0 51.4 Corrected 51Cr- EDTA ≥GFR 60
(N=1568)Corrected 51EDTA 83.2 (15.4) CKD- EPI 96.7 (16.0) 13.5 14.9 -16.3 to 43.3 74.4 MDRD 97.7 (25.2) 14.5 22.8 -31.1 to 60.1 70.0 Adjusted = including ethnicity correction factor; Unadjusted = excluding ethnicity correction factor
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