Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;16(10):1552-1559.
doi: 10.2215/CJN.05490421.

Transplant Clinician Opinions on Use of Race in the Estimation of Glomerular Filtration Rate

Mona D Doshi  1 , Neeraj Singh  2 , Benjamin E Hippen  3 , Kenneth J Woodside  1 , Prince Mohan  4 , Hannah L Byford  5 , Matthew Cooper  6 , Darshana M Dadhania  7 , Sruthi Ainapurapu  8 , Krista L Lentine  8
Affiliations

Transplant Clinician Opinions on Use of Race in the Estimation of Glomerular Filtration Rate

Mona D Doshi et al. Clin J Am Soc Nephrol. 2021 Oct.

Abstract

Background and objectives: Current race-based eGFR calculators assign a higher eGFR value to Black patients, which could affect the care of kidney transplant candidates and potential living donors.

Design, setting, participants, & measurements: We conducted a survey of staff at adult kidney transplant centers in the United States (December 17, 2020 to February 28, 2021) to assess opinions on use of race-based eGFR equations for waitlisting and living donor candidate evaluation, availability of serum cystatin C testing and measured GFR, and related practices.

Results: Respondents represented 57% (124 of 218) of adult kidney transplant programs, and the responding centers conducted 70% of recent kidney transplant volume. Most (93%) programs use serum creatinine-based eGFR for listing candidates. However, only 6% of respondents felt that current race-based eGFR calculators are appropriate, with desire for change grounded in concerns for promotion of health care disparities by current equations and inaccuracies in reporting of race. Most respondents (70%) believed that elimination of race would allow more preemptive waitlisting for Black patients, but a majority (79%) also raised concerns that such an approach could incur harms. More than one third of the responding programs lacked or were unsure of availability of testing for cystatin C or measured GFR. At this time, 40% of represented centers did not plan to remove race from eGFR calculators, 46% were planning to remove, and 15% had already done so. There was substantial variability in eGFR reporting and listing of multiracial patients with some Black ancestry. There was no difference in GFR acceptance thresholds for Black versus non-Black living donors.

Conclusions: This national survey highlights a broad consensus that extant approaches to GFR estimation are unsatisfactory, but it also identified a range of current opinions.

Keywords: ambulatory care facilities; equity; ethnicity; glomerular filtration rate; transplantation.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Reported health system practices related to use of race in GFR estimation.
See this image and copyright information in PMC

Comment in

References

    1. Miller WG, Jones GRD: Estimated glomerular filtration rate; laboratory implementation and current global status. Adv Chronic Kidney Dis 25: 7–13, 2018 - PubMed
    1. Levey AS, Titan SM, Powe NR, Coresh J, Inker LA: Kidney disease, race, and GFR estimation. Clin J Am Soc Nephrol 15: 1203–1212, 2020 - PMC - PubMed
    1. Diao JA, Inker LA, Levey AS, Tighiouart H, Powe NR, Manrai AK: In search of a better equation: Performance and equity in estimates of kidney function. N Engl J Med 384: 396–399, 2021 - PMC - PubMed
    1. Vyas DA, Eisenstein LG, Jones DS: Hidden in plain sight: Reconsidering the use of race correction in clinical algorithms. N Engl J Med 383: 874–882, 2020 - PubMed
    1. Eneanya ND, Yang W, Reese PP: Reconsidering the consequences of using race to estimate kidney function. JAMA 322: 113–114, 2019 - PubMed

Publication types

MeSH terms