CKD Prevalence and Incidence in Hispanic/Latino Adults Using Race-Free Estimated Glomerular Filtration Rate Equations

Abstract

Rationale & objective: The impact of the race-free Chronic kidney disease Epidemiology Collaboration (CKD-EPI) 2021 estimating glomerular filtration rate equations (eGFR) on CKD prevalence and incidence in Hispanic/Latino adults is unknown. This study evaluated changes in CKD prevalence and incidence in Hispanic/Latino adults using race-free 2021 CKD-EPI equations.

Study design: A prospective population-based cohort.

Setting & participants: Estimates of CKD prevalence used data from 14,944 cohort participants. Incidence rates analyses used data from 9,038 participants who completed a visit ∼6 years following a baseline visit.

Analytical approach: Prevalence of Kidney Disease Improving Global Outcomes eGFR categories and CKD (defined as eGFR < 60 mL/min per 1.73m² or albuminuria-to-creatinine ratio [ACR] ≥ 30 mg/g) were compared using CKD-EPI 2009 and 2021 creatinine (cr)-based equations, and the 2012 and 2021 creatinine-cystatin C (cr-cys) equations. Reclassification across eGFR categories was estimated. Poisson regression was used to estimate rates of incident CKD (defined as eGFR < 60 mL/min/1.73m² with eGFR decline > 1 mL/min/1.73m² per year, or ACR ≥ 30 mg/g).

Results: The prevalence of eGFR > 90 mL/min/1.73m² was higher using 2021 CKD-EPIcr than 2009 CKD-EPIcr (77.8 vs 72.1); 7.4% were classified to a higher (less severe) eGFR category. Prevalence of CKD was lower using 2021 CKD-EPIcr (10.5 vs 11.2%) and differences were more pronounced among those >55 years (20.5 vs 22.7%) and individuals of Puerto Rican background (13.8 vs 15.0%). Incidence rates were lower using the 2021 equation (9.2 vs 9.6 per 1,000 person-years) and differences were most prominent for those >55 years (20.1 vs 22.1 per 1,000 person-years). Similar findings were observed comparing eGFRcr-cys equations.

Limitations: The eGFR equations evaluated have not been validated in Hispanics/Latinos.

Conclusions: The 2021 CKD-EPI equations estimate lower CKD prevalence and incidence in US Hispanic/Latino adults, which has implications for public health and clinical practice.

Keywords: Hispanic/Latinos; chronic kidney disease; chronic kidney disease incidence; chronic kidney disease prevalence; eGFR equations.

Figure 1

Analytic cohort flow chart.

Figure 2

Baseline CKD prevalence (defined as an eGFR < 60 mL/min/1.73m² or urine albumin-to-creatinine ratio (ACR) ≥ 30 mg/g), percentage (95% CI) by eGFR equation, overall and by sex and age (A), background group (B), and status of diabetes and hypertension (C).

Figure 3

CKD incidence rates by eGFR equation, per 1,000 person-years (95% CI) overall and by sex and age (A), by background group (B), and by diabetes and hypertension status (C).