The following is a summary of “Comparison of Race-Based and Non-Race-Based Glomerular Filtration Rate Equations for the Assessment of Renal Functional Risk Before Nephrectomy,” published in the FEBRUARY 2023 issue of Urology by Antony, et al.
For a study, researchers sought to compare the accuracy of race-based and race-neutral estimated glomerular filtration rate (eGFR) calculators in patients undergoing kidney surgery.
They analyzed data from kidney surgeries performed at their institution between 2006 and 2021. They collected demographic information, serum creatinine (SCr) levels, protein dipstick results, and creatinine clearance (CrCl) values within 1 week before surgery. The eGFR was calculated using three models: Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI 2009), and CKD-EPI 2021. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria for CKD staging and prognosis were used to classify patients, with urine CrCl as the benchmark for analysis. They evaluated the accuracy of the eGFR calculators using receiver operating characteristic (ROC) analysis to assess their binary discrimination of eGFR less than 60 mL/min, and compared the agreement between eGFR and urine CrCl for CKD staging.
The analysis included data from 554 kidney surgeries in 336 patients, with a median age of 47 and 62% male. Of the cohort, 8.1% (n=45) were Black, and 80% (n=441) were White. The results showed that the GFR from 24-hour urine CrCl normalized by body surface area did not significantly differ from eGFR calculated by SCr-based equations. However, the proportion of patients with eGFR <60 was significantly different when using MDRD, CKD-EPI 2009, and CKD-EPI 2021 equations compared to CrCl (P<.001), but the eGFR calculators performed equivalently in the staging of CKD, predicting GFR of less than 60, and classifying CKD prognosis of “moderately increased or higher.”
In conclusion, the study found that a race-neutral eGFR calculator can perform similarly to established eGFR calculators while reducing biases related to racial disparities in nephrectomy decision-making.