National Estimates of CKD Prevalence and Potential Impact of Estimating Glomerular Filtration Rate Without Race.
Adrenergic beta-1 Receptor Antagonists
/ therapeutic use
Adult
Black or African American
/ statistics & numerical data
Aged
Aged, 80 and over
Analgesics, Opioid
/ therapeutic use
Anti-Bacterial Agents
Anticonvulsants
/ therapeutic use
Atenolol
/ therapeutic use
Ciprofloxacin
/ therapeutic use
Female
Gabapentin
/ therapeutic use
Glomerular Filtration Rate
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
/ therapeutic use
Hypoglycemic Agents
Male
Mathematical Concepts
Metformin
/ therapeutic use
Middle Aged
Nutrition Surveys
Prevalence
Prognosis
Race Factors
Renal Insufficiency, Chronic
/ classification
Risk Factors
Rosuvastatin Calcium
/ therapeutic use
Tramadol
/ therapeutic use
United States
/ epidemiology
Veterans
/ statistics & numerical data
Young Adult
chronic kidney disease
glomerular filtration rate
Journal
Journal of the American Society of Nephrology : JASN
ISSN: 1533-3450
Titre abrégé: J Am Soc Nephrol
Pays: United States
ID NLM: 9013836
Informations de publication
Date de publication:
01 06 2021
01 06 2021
Historique:
received:
22
12
2020
accepted:
12
03
2021
pubmed:
8
5
2021
medline:
5
10
2021
entrez:
7
5
2021
Statut:
ppublish
Résumé
The implications of removing the adjustment for Black race in equations to eGFR on the prevalence of CKD and management strategies are incompletely understood. We estimated changes in CKD prevalence and the potential effect on therapeutic drug prescriptions and prediction of kidney failure if race adjustment were removed from the CKD-EPI GFR estimating equation. We used cross-sectional and longitudinal data from adults aged ≥18 years in the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2016, and the Veterans Affairs (VA) Health Care System in 2015. In the VA cohort, we assessed use of common medications that require dose adjustment on the basis of kidney function, and compared the prognostic accuracy of the Kidney Failure Risk Equation with versus without race adjustment of eGFR. The prevalence of CKD among Black adults increased from 5.2% to 10.6% in NHANES, and from 12.4% to 21.6% in the VA cohort after eliminating race adjustment. Among Black veterans, 41.0% of gabapentin users, 33.5% of ciprofloxacin users, 24.0% of metformin users, 6.9% of atenolol users, 6.6% of rosuvastatin users, and 5.8% of tramadol users were reclassified to a lower eGFR for which dose adjustment or discontinuation is recommended. Without race adjustment of eGFR, discrimination of the Kidney Failure Risk Equation among Black adults remained high and calibration was marginally improved overall, with better calibration at higher levels of predicted risk. Removal of race adjustment from CKD-EPI eGFR would double the estimated prevalence of CKD among Black adults in the United States. Such a change is likely to affect a sizeable number of drug-dosing decisions. It may also improve the accuracy of kidney failure risk prediction among higher-risk Black adults.
Sections du résumé
BACKGROUND
The implications of removing the adjustment for Black race in equations to eGFR on the prevalence of CKD and management strategies are incompletely understood.
METHODS
We estimated changes in CKD prevalence and the potential effect on therapeutic drug prescriptions and prediction of kidney failure if race adjustment were removed from the CKD-EPI GFR estimating equation. We used cross-sectional and longitudinal data from adults aged ≥18 years in the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2016, and the Veterans Affairs (VA) Health Care System in 2015. In the VA cohort, we assessed use of common medications that require dose adjustment on the basis of kidney function, and compared the prognostic accuracy of the Kidney Failure Risk Equation with versus without race adjustment of eGFR.
RESULTS
The prevalence of CKD among Black adults increased from 5.2% to 10.6% in NHANES, and from 12.4% to 21.6% in the VA cohort after eliminating race adjustment. Among Black veterans, 41.0% of gabapentin users, 33.5% of ciprofloxacin users, 24.0% of metformin users, 6.9% of atenolol users, 6.6% of rosuvastatin users, and 5.8% of tramadol users were reclassified to a lower eGFR for which dose adjustment or discontinuation is recommended. Without race adjustment of eGFR, discrimination of the Kidney Failure Risk Equation among Black adults remained high and calibration was marginally improved overall, with better calibration at higher levels of predicted risk.
CONCLUSIONS
Removal of race adjustment from CKD-EPI eGFR would double the estimated prevalence of CKD among Black adults in the United States. Such a change is likely to affect a sizeable number of drug-dosing decisions. It may also improve the accuracy of kidney failure risk prediction among higher-risk Black adults.
Identifiants
pubmed: 33958490
pii: 00001751-202106000-00019
doi: 10.1681/ASN.2020121780
pmc: PMC8259653
doi:
Substances chimiques
Adrenergic beta-1 Receptor Antagonists
0
Analgesics, Opioid
0
Anti-Bacterial Agents
0
Anticonvulsants
0
Hydroxymethylglutaryl-CoA Reductase Inhibitors
0
Hypoglycemic Agents
0
Tramadol
39J1LGJ30J
Atenolol
50VV3VW0TI
Ciprofloxacin
5E8K9I0O4U
Gabapentin
6CW7F3G59X
Rosuvastatin Calcium
83MVU38M7Q
Metformin
9100L32L2N
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1454-1463Informations de copyright
Copyright © 2021 by the American Society of Nephrology.
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