Removing race from the CKD-EPI equation and its impact on prognosis in a predominantly White European population

Fu, E.L.; Coresh, J.; Grams, M.E.; Clase, C.M.; Elinder, C.G.; Paik, J.; ... ; Carrero, J.J. (2022)

Article / Letter to editor

Background While American nephrology societies recommend using the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation without a Black race coefficient, it is unknown how this would impact disease distribution, prognosis and kidney failure risk prediction in predominantly White non-US populations. Methods We studied 1.6 million Stockholm adults with serum/plasma creatinine measurements between 2007 and 2019. We calculated changes in eGFR and reclassification across KDIGO GFR categories when changing from the 2009 to 2021 CKD-EPI equation; estimated associations between eGFR and the clinical outcomes kidney failure with replacement therapy (KFRT), (cardiovascular) mortality and major adverse cardiovascular events using Cox regression; and investigated prognostic accuracy (discrimination and calibration) of both equations within the Kidney Failure Risk Equation. Results Compared with the 2009 equation, the 2021 equation yielded a higher eGFR by a median [interquartile range (IQR)] of 3.9 (2.9-4.8) mL/min/1.73 m(2), which was larger at older age and for men. Consequently, 9.9% of the total population and 36.2% of the population with CKD G3a-G5 was reclassified to a higher eGFR category. Reclassified individuals exhibited a lower risk of KFRT, but higher risks of all-cause/cardiovascular death and major adverse cardiovascular events, compared with non-reclassified participants of similar eGFR. eGFR by both equations strongly predicted study outcomes, with equal discrimination and calibration for the Kidney Failure Risk Equation. Conclusions Implementing the 2021 CKD-EPI equation in predominantly White European populations would raise eGFR by a modest amount (larger at older age and in men) and shift a major proportion of CKD patients to a higher eGFR category. eGFR by both equations strongly predicted outcomes.

• CKD-EPI
• creatinine
• epidemiology
• glomerular filtration rate
• kidney diseases

• All authors: Fu, E.L.; Coresh, J.; Grams, M.E.; Clase, C.M.; Elinder, C.G.; Paik, J.; Ramspek, C.; Inker, L.A.; Levey, A.S.; Dekker, F.W.; Carrero, J.J.
• Date: 2022-06-11
• Journal: Nephrology Dialysis Transplantation
• Pages: 119 - 128
• DOI: doi:10.1093/ndt/gfac197