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Marzinke MA, Greene DN, Bossuyt PM, et al. Limited Evidence for Use of a Black Race Modifier in eGFR Calculations: A Systematic Review. Clin Chem. 2021;doi: 10.1093/clinchem/hvab279.
Marzinke, M. A., Greene, D. N., Bossuyt, P. M., Chambliss, A. B., Cirrincione, L. R., McCudden, C. R., Melanson, S. E. F., Noguez, J. H., Patel, K., Radix, A. E., Takwoingi, Y., Winston-McPherson, G., Young, B. A., & Hoenig, M. P. (2021). Limited Evidence for Use of a Black Race Modifier in eGFR Calculations: A Systematic Review. Clinical chemistry, . https://doi.org/10.1093/clinchem/hvab279
Marzinke, Mark A, et al. "Limited Evidence for Use of a Black Race Modifier in eGFR Calculations: A Systematic Review." Clinical chemistry vol. (2021). doi: https://doi.org/10.1093/clinchem/hvab279
Marzinke MA, Greene DN, Bossuyt PM, Chambliss AB, Cirrincione LR, McCudden CR, Melanson SEF, Noguez JH, Patel K, Radix AE, Takwoingi Y, Winston-McPherson G, Young BA, Hoenig MP. Limited Evidence for Use of a Black Race Modifier in eGFR Calculations: A Systematic Review. Clin Chem. 2021 Dec 20; doi: 10.1093/clinchem/hvab279. Epub 2021 Dec 20. PMID: 34927677.
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Clin Chem. 2021 Dec 20; doi: 10.1093/clinchem/hvab279. Epub 2021 Dec 20.

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

Clinical chemistry

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

Affiliations

  1. Departments of Pathology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  2. Department of Laboratory Medicine and Pathology; University of Washington, Seattle, WA; Kaiser Permanente, Renton, WA.
  3. Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
  4. Department of Pathology, University of Southern California, Los Angeles, CA.
  5. Department of Pharmacy, University of Washington, Seattle, WA.
  6. Department of Pathology and Laboratory Medicine, The Ottawa Hospital; University of Ottawa; Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada.
  7. Department of Pathology; Brigham and Women's Hospital; Harvard Medical School, Boston, MA.
  8. Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH.
  9. Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA.
  10. Callen-Lorde Community Health Center, New York, NY.
  11. 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, United Kingdom.
  12. Henry Ford Health System, Detroit, MI.
  13. Office of Healthcare Equity, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
  14. Renal Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA.

PMID: 34927677 DOI: 10.1093/clinchem/hvab279

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.

© 2021 American Association for Clinical Chemistry.

Keywords: Black Race Modifier; Chronic kidney disease; Disparity; Glomerular filtration rate; eGFR

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