Limited evidence for use of a black race modifier in eGFR calculations: a systematic review

Mark A. Marzinke, Dina N. Greene, Patrick M. Bossuyt, Allison B. Chambliss, Lauren R. Cirrincione, 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

Research output: Contribution to journalReview articlepeer-review

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. 8,632 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.
Original languageEnglish
Article numberhvab279
JournalClinical Chemistry
Early online date20 Dec 2021
DOIs
Publication statusE-pub ahead of print - 20 Dec 2021

Keywords

  • Glomerular filtration rate
  • Disparity
  • Chronic kidney disease
  • Black Race Modifier
  • eGFR

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