Examining the Potential Impact of Race Multiplier Utilization in Estimated Glomerular Filtration Rate Calculation on Afr
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Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 2Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 3Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Department of Diversity, Inclusion, and Experience, Brigham and Women’s Hospital, Boston, MA, USA; 5Department of Quality and Safety, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 6EqualHealth, Tabarre, Haiti; 7 EqualHealth, Brookline, MA, USA; 8Department of Quality, Patient Experience and Equity, Partners HealthCare, Boston, MA, USA; 9Center for Population Health, Partners HealthCare, Boston, MA, USA.
BACKGROUND: Advancing health equity entails reducing disparities in care. African-American patients with chronic kidney disease (CKD) have poorer outcomes, including dialysis access placement and transplantation. Estimated glomerular filtration rate (eGFR) equations, which assign higher eGFR values to African-American patients, may be a mechanism for inequitable outcomes. Electronic health record–based registries enable population-based examination of care across racial groups. OBJECTIVE: To examine the impact of the race multiplier for African-Americans in the CKD-EPI eGFR equation on CKD classification and care delivery. DESIGN: Cross-sectional study SETTING: Two large academic medical centers and affiliated community primary care and specialty practices. PARTICIPANTS: A total of 56,845 patients in the Partners HealthCare System CKD registry in June 2019, among whom 2225 (3.9%) were African-American. MEASUREMENTS: Exposures included race, age, sex, comorbidities, and eGFR. Outcomes were transplant referral and dialysis access placement. RESULTS: Of 2225 African-American patients, 743 (33.4%) would hypothetically be reclassified to a more severe CKD stage if the race multiplier were removed from the CKD-EPI equation. Similarly, 167 of 687 (24.3%) would be reclassified from stage 3B to stage 4. Finally, 64 of 2069 patients (3.1%) would be reassigned from eGFR > 20 ml/min/1.73 m2 to eGFR ≤ 20 ml/min/ 1.73 m2, meeting the criterion for accumulating kidney transplant priority. Zero of 64 African-American patients with an eGFR ≤ 20 ml/min/1.73 m2 after the race multiplier was removed were referred, evaluated, or waitlisted for kidney transplant, compared to 19.2% of AfricanAmerican patients with eGFR ≤ 20 ml/min/1.73 m2 with the default CKD-EPI equation.
Statement of no Previous Publication The results presented in this paper have not been published previously in whole or part. Received May 9, 2020 Accepted September 28, 2020
LIMITATIONS: Single healthcare system in the Northeastern United States and relatively small AfricanAmerican patient cohort may limit generalizability. CONCLUSIONS: Our study reveals a meaningful impact of race-adjusted eGFR on the care provided to the AfricanAmerican CKD patient population. J Gen Intern Med DOI: 10.1007/s11606-020-06280-5 © Society of Ge
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