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Observational Study
. 2023 Feb 8;76(3):461-468.
doi: 10.1093/cid/ciac731.

Effect of Adopting the New Race-Free 2021 Chronic Kidney Disease Epidemiology Collaboration Estimated Glomerular Filtration Rate Creatinine Equation on Racial Differences in Kidney Disease Progression Among People With Human Immunodeficiency Virus: An Observational Study

Anthony N Muiru  1   2 , Erin Madden  1   3 , Rebecca Scherzer  1   3 , Michael A Horberg  4 , Michael J Silverberg  5 , Marina B Klein  6 , Angel M Mayor  7 , M John Gill  8 , Sonia Napravnik  9 , Heidi M Crane  10 , Vincent C Marconi  11   12 , John R Koethe  13 , Alison G Abraham  14   15 , Keri N Althoff  15 , Gregory M Lucas  16 , Richard D Moore  16 , Michael G Shlipak  1   3 , Michelle M Estrella  1   2   3
Affiliations
Observational Study

Effect of Adopting the New Race-Free 2021 Chronic Kidney Disease Epidemiology Collaboration Estimated Glomerular Filtration Rate Creatinine Equation on Racial Differences in Kidney Disease Progression Among People With Human Immunodeficiency Virus: An Observational Study

Anthony N Muiru et al. Clin Infect Dis. .

Abstract

Background: The impact of adopting a race-free estimated glomerular filtration rate (eGFR) creatinine (eGFRcr) equation on racial differences in chronic kidney disease (CKD) progression among people with human immunodeficiency virus (PWH) is unknown.

Methods: We defined eGFR stages using the original race-adjusted Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFRcr equation and the new race-free CKD-EPI eGFRcr equation. We then estimated 5-year probabilities of transitioning from baseline kidney function to more advanced eGFR stages and examined the association of race (black vs white) with rates of CKD progression using Markov models.

Results: With the race-adjusted eGFRcr equation, black participants (n = 31 298) had a lower risk of progressing from eGFR stage 1 to 2 (hazard ratio [HR], 0.77; 95% confidence interval [CI], .73-.82), an equal risk of progressing from stage 2 to 3 (1.00; .92-.07) and a 3-fold risk of progressing from stage 3 to 4 or 5 (3.06; 2.60-3.62), compared with white participants (n = 27 542). When we used the race-free eGFRcr equation, 16% of black participants were reclassified into a more severe eGFR stage at baseline. The reclassified black individuals had a higher prevalence of CKD risk factors than black PWH who were not reclassified. With the race-free eGFRcr equation, black participants had a higher risk of disease progression across all eGFR stages than white participants.

Conclusions: The original eGFRcr equation systematically masked a subgroup of black PWH who are at high-risk of CKD progression. The new race-free eGFRcr equation unmasks these individuals and may allow for earlier detection and management of CKD.

Keywords: CKD; ESKD; HIV; eGFR; race.

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Conflict of interest statement

Potential conflicts of interest. A. N. M. reports grants from the University of California, San Francisco, Dean’s Diversity award (Watson Scholar) and the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK114014 diversity supplement and K23DK119562). M. J. G. reports grants from the NIH and participation as an ad hoc member of the human immunodeficiency virus national advisory board with Merck, Gilead, and ViiV. M. G. S. reports grants from the National Institute on Aging, the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Heart, Lung, and Blood Institute, NIH, during the conduct of the study; personal fees from Cricket Health, Intercept Pharmaceuticals, Bayer Pharmaceuticals, AstraZeneca, and Boehringer Ingelheim; and grants from Bayer Pharmaceuticals, outside the submitted work. M. M. E. reports grants from the National Institute of Diabetes and Digestive and Kidney Diseases during the conduct of the study; consulting fees from Boehringer-Ingelheim, the Law Office of A. Craig Eiland, and AstraZeneca; and a grant from Bayer. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Figures

Figure 1.
Figure 1.
A, Baseline estimated glomerular filtration rate (eGFR) distribution among white (A) and black (B) participants using the original 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR creatinine (eGFRcr) equation and the new race-free 2021 CKD-EPI eGFRcr equation.
See this image and copyright information in PMC

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