New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race
- PMID: 34554658
- PMCID: PMC8822996
- DOI: 10.1056/NEJMoa2102953
New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race
Abstract
Background: Current equations for estimated glomerular filtration rate (eGFR) that use serum creatinine or cystatin C incorporate age, sex, and race to estimate measured GFR. However, race in eGFR equations is a social and not a biologic construct.
Methods: We developed new eGFR equations without race using data from two development data sets: 10 studies (8254 participants, 31.5% Black) for serum creatinine and 13 studies (5352 participants, 39.7% Black) for both serum creatinine and cystatin C. In a validation data set of 12 studies (4050 participants, 14.3% Black), we compared the accuracy of new eGFR equations to measured GFR. We projected the prevalence of chronic kidney disease (CKD) and GFR stages in a sample of U.S. adults, using current and new equations.
Results: In the validation data set, the current creatinine equation that uses age, sex, and race overestimated measured GFR in Blacks (median, 3.7 ml per minute per 1.73 m2 of body-surface area; 95% confidence interval [CI], 1.8 to 5.4) and to a lesser degree in non-Blacks (median, 0.5 ml per minute per 1.73 m2; 95% CI, 0.0 to 0.9). When the adjustment for Black race was omitted from the current eGFR equation, measured GFR in Blacks was underestimated (median, 7.1 ml per minute per 1.73 m2; 95% CI, 5.9 to 8.8). A new equation using age and sex and omitting race underestimated measured GFR in Blacks (median, 3.6 ml per minute per 1.73 m2; 95% CI, 1.8 to 5.5) and overestimated measured GFR in non-Blacks (median, 3.9 ml per minute per 1.73 m2; 95% CI, 3.4 to 4.4). For all equations, 85% or more of the eGFRs for Blacks and non-Blacks were within 30% of measured GFR. New creatinine-cystatin C equations without race were more accurate than new creatinine equations, with smaller differences between race groups. As compared with the current creatinine equation, the new creatinine equations, but not the new creatinine-cystatin C equations, increased population estimates of CKD prevalence among Blacks and yielded similar or lower prevalence among non-Blacks.
Conclusions: New eGFR equations that incorporate creatinine and cystatin C but omit race are more accurate and led to smaller differences between Black participants and non-Black participants than new equations without race with either creatinine or cystatin C alone. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.).
Copyright © 2021 Massachusetts Medical Society.
Figures

Comment in
-
Time to Eliminate Health Care Disparities in the Estimation of Kidney Function.N Engl J Med. 2021 Nov 4;385(19):1804-1806. doi: 10.1056/NEJMe2114918. Epub 2021 Sep 23. N Engl J Med. 2021. PMID: 34554659 No abstract available.
-
Removal of race from estimation of kidney function.Nat Rev Nephrol. 2022 Apr;18(4):201-202. doi: 10.1038/s41581-021-00524-1. Nat Rev Nephrol. 2022. PMID: 35013595 No abstract available.
-
Response to Letter to the Editor: The Effect of Gender-Affirming Hormone Therapy on Serum Creatinine in Transgender Individuals.Endocr Pract. 2022 Apr;28(4):450. doi: 10.1016/j.eprac.2022.01.009. Epub 2022 Feb 3. Endocr Pract. 2022. PMID: 35124242 No abstract available.
-
New Equations for Estimating the GFR without Race.N Engl J Med. 2022 Apr 28;386(17):1669-1670. doi: 10.1056/NEJMc2119761. N Engl J Med. 2022. PMID: 35476657 No abstract available.
-
New Equations for Estimating the GFR without Race.N Engl J Med. 2022 Apr 28;386(17):1670. doi: 10.1056/NEJMc2119761. N Engl J Med. 2022. PMID: 35476658 No abstract available.
-
New Equations for Estimating the GFR without Race.N Engl J Med. 2022 Apr 28;386(17):1670-1671. doi: 10.1056/NEJMc2119761. N Engl J Med. 2022. PMID: 35476659 No abstract available.
-
New Equations for Estimating the GFR without Race.N Engl J Med. 2022 Apr 28;386(17):1671-1672. doi: 10.1056/NEJMc2119761. N Engl J Med. 2022. PMID: 35476660 No abstract available.
-
The Impact of the New CKD-EPI Equation on GFR Estimation in the Elderly.Dtsch Arztebl Int. 2022 Oct 14;119(41):694-695. doi: 10.3238/arztebl.m2022.0258. Dtsch Arztebl Int. 2022. PMID: 36598087 Free PMC article. No abstract available.
References
-
- Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function — measured and estimated glomerular filtration rate. N Engl J Med 2006; 354: 2473–83. - PubMed
-
- Levey AS, Coresh J, Tighiouart H, Greene T, Inker LA. Measured and estimated glomerular filtration rate: current status and future directions. Nat Rev Nephrol 2020; 16:51–64. - PubMed
-
- Miller WG, Jones GRD. Estimated glomerular filtration rate: laboratory implementation and current global status. Adv Chronic Kidney Dis 2018; 25: 7–13. - PubMed
Publication types
MeSH terms
Substances
Grants and funding
- U01DK061021/DK/NIDDK NIH HHS/United States
- UL1-TR-002556/TR/NCATS NIH HHS/United States
- UL1 TR000165/TR/NCATS NIH HHS/United States
- P20 GM109036/TR/NCATS NIH HHS/United States
- R01 DK113111/DK/NIDDK NIH HHS/United States
- U01 DK053869/DK/NIDDK NIH HHS/United States
- UL1 TR003096/TR/NCATS NIH HHS/United States
- RR033179/TR/NCATS NIH HHS/United States
- R01 DK116790/DK/NIDDK NIH HHS/United States
- UL1TR000003/TR/NCATS NIH HHS/United States
- N01-HC-95159/HL/NHLBI NIH HHS/United States
- RR00585/RR/NCRR NIH HHS/United States
- U01 DK094176/DK/NIDDK NIH HHS/United States
- TR000165/TR/NCATS NIH HHS/United States
- N01-HC-95166/HL/NHLBI NIH HHS/United States
- UL1-TR-001422/TR/NCATS NIH HHS/United States
- 1R01DK116790/DK/NIDDK NIH HHS/United States
- N01-DK-6-2285/DK/NIDDK NIH HHS/United States
- N01-DK-7-2291/DK/NIDDK NIH HHS/United States
- DK056956/DK/NIDDK NIH HHS/United States
- UL1-TR-002319-02/TR/NCATS NIH HHS/United States
- UL1TR000439/TR/NCATS NIH HHS/United States
- R01-DK082447/DK/NIDDK NIH HHS/United States
- P30-DK-020572/DK/NIDDK NIH HHS/United States
- UL1-TR-001420/TR/NCATS NIH HHS/United States
- U01DK060980/DK/NIDDK NIH HHS/United States
- RR000032/RR/NCRR NIH HHS/United States
- UL1 TR002538/TR/NCATS NIH HHS/United States
- R34-DK-097808/DK/NIDDK NIH HHS/United States
- N01-HC-95160/HL/NHLBI NIH HHS/United States
- U01 DK060963/DK/NIDDK NIH HHS/United States
- U01DK060902/DK/NIDDK NIH HHS/United States
- TR000005/TR/NCATS NIH HHS/United States
- U01DK060984/DK/NIDDK NIH HHS/United States
- N01-HC-95167/HL/NHLBI NIH HHS/United States
- RR23940/RR/NCRR NIH HHS/United States
- UL1 RR029887/TR/NCATS NIH HHS/United States
- HL146240/HL/NHLBI NIH HHS/United States
- DK106912/DK/NIDDK NIH HHS/United States
- U01 DK35073/DK/NIDDK NIH HHS/United States
- TR001417/TR/NCATS NIH HHS/United States
- U01DK060990/DK/NIDDK NIH HHS/United States
- M01 RR-16500/TR/NCATS NIH HHS/United States
- R01 DK097020/DK/NIDDK NIH HHS/United States
- N01-HC-95163/HL/NHLBI NIH HHS/United States
- R03-DK-094484/DK/NIDDK NIH HHS/United States
- P30-AG-02482/AG/NIA NIH HHS/United States
- U01 DK061022/DK/NIDDK NIH HHS/United States
- P30 DK036836/DK/NIDDK NIH HHS/United States
- RR025777/TR/NCATS NIH HHS/United States
- HL146333/HL/NHLBI NIH HHS/United States
- P30-AG-08808/AG/NIA NIH HHS/United States
- DK056957/DK/NIDDK NIH HHS/United States
- UL1 TR-000424/TR/NCATS NIH HHS/United States
- TR000454/TR/NCATS NIH HHS/United States
- UL1-TR-001079/TR/NCATS NIH HHS/United States
- N01-HC-95168/HL/NHLBI NIH HHS/United States
- UL1 RR025752/TR/NCATS NIH HHS/United States
- R01DK097020/DK/NIDDK NIH HHS/United States
- TR000135/TR/NCATS NIH HHS/United States
- R01DK119199/DK/NIDDK NIH HHS/United States
- M01 RR00071/MD/NIMHD NIH HHS/United States
- UC4-DK-101108/DK/NIDDK NIH HHS/United States
- T32 DK07013/NH/NIH HHS/United States
- DK090728/DK/NIDDK NIH HHS/United States
- N01-HC-95162/HL/NHLBI NIH HHS/United States
- UL1-TR-002494/DK/NIDDK NIH HHS/United States
- UL1-TR-002319/TR/NCATS NIH HHS/United States
- U01DK061022/DK/NIDDK NIH HHS/United States
- RR025008/TR/NCATS NIH HHS/United States
- U01 DK066013/DK/NIDDK NIH HHS/United States
- RR000039/RR/NCRR NIH HHS/United States
- DK51975/DK/NIDDK NIH HHS/United States
- N01-HC-95164/HL/NHLBI NIH HHS/United States
- UL1 TR002556/TR/NCATS NIH HHS/United States
- HL146193/HL/NHLBI NIH HHS/United States
- U01 DK094157/DK/NIDDK NIH HHS/United States
- TR000001/TR/NCATS NIH HHS/United States
- U01DK060963/DK/NIDDK NIH HHS/United States
- U01 DK045388/DK/NIDDK NIH HHS/United States
- N01-HC-95165/HL/NHLBI NIH HHS/United States
- RR024153/TR/NCATS NIH HHS/United States
- U24DK060990/DK/NIDDK NIH HHS/United States
- UL1 TR001417/TR/NCATS NIH HHS/United States
- DK056961/DK/NIDDK NIH HHS/United States
- HL146208/HL/NHLBI NIH HHS/United States
- UL1-TR-001105/TR/NCATS NIH HHS/United States
- UL1TR000433/TR/NCATS NIH HHS/United States
- UL1RR029879/TR/NCATS NIH HHS/United States
- UL1 RR025777/TR/NCATS NIH HHS/United States
- P30-DK-036836/DK/NIDDK NIH HHS/United States
- RR024150/TR/NCATS NIH HHS/United States
- DK056943/DK/NIDDK NIH HHS/United States
- UL1 TR002544/TR/NCATS NIH HHS/United States
- UL1-TR-000040/TR/NCATS NIH HHS/United States
- HL146201/HL/NHLBI NIH HHS/United States
- U01DK061028/DK/NIDDK NIH HHS/United States
- N01-HC-95169/HL/NHLBI NIH HHS/United States
- N01-HC-95161/HL/NHLBI NIH HHS/United States
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials
Miscellaneous