Examining the Potential Impact of Race Multiplier Utilization in Estimated Glomerular Filtration Rate Calculation on African-American Care Outcomes
Open accessAbstract
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 m 2 to eGFR ≤ 20 ml/min/1.73 m 2, meeting the criterion for accumulating kidney transplant priority. Zero of 64 African-American patients with an eGFR ≤ 20 ml/min/1.73 m 2 after the race multiplier was removed were referred, evaluated, or waitlisted for kidney transplant, compared to 19.2% of African-American patients with eGFR ≤ 20 ml/min/1.73 m 2 with the default CKD-EPI equation. Limitations Single healthcare system in the Northeastern United States and relatively small African-American patient cohort may limit generalizability. Conclusions Our study reveals a meaningful impact of race-adjusted eGFR on the care provided to the African-American CKD patient population.
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Removing race corrections in the treatment of kidney disease would result in a third of Black kidney disease patients in the United States receiving an elevated level of care.
“a recent analysis of the impact of removing race corrections in the treatment of kidney disease indicated that a third of Black kidney disease patients in the United States would receive an elevated level of care if the race corrections were dropped.27”
From Challenging Race-Based Medicine Through Historical Education About the Social Construction of Race (2023) · cites this paper as [27]
The Results report that 743 of 2,225 African-American patients (33.4%) in one healthcare system would be reclassified to a more severe CKD stage if the race multiplier were removed. The paper discusses potential care implications, but it does not establish that one-third of Black kidney disease patients across the United States would actually receive an elevated level of care. The Abstract also cautions that the single-system sample may limit generalizability; page numbers were not supplied. (LLM, conf=0.90)
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- Authors
- Ahmed, S., Nutt, C. T., Eneanya, N. D., Reese, P. P., Sivashanker, K., Morse, M., Sequist, T., & Mendu, M. L.
- Affiliations
- Brigham and Women's Hospital (US)
- University of Pennsylvania (US)
- Corresponding author
- Ahmed, Salman
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2020-10-15
- Volume
- 36
- Issue
- 2
- Pages
- 464-471
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC7878608
- OpenAlex
- W3092668967
- Cited by
- 147
- References
- 6
- Citations by year
- 2026: 10 · 2025: 17 · 2024: 21 · 2023: 22 · 2022: 32 · 2021: 43 · 2020: 2
- FWCI
- 15.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Brigham and Women's Hospital (Health Equity Improvement Program Grant)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Race, Genetics, and Society
- Keywords
- estimated glomerular filtration rate, CKD-EPI equation, African American patients, chronic kidney disease, racial disparities, CKD staging, health equity
- MeSH terms
- Black or African American, Cross-Sectional Studies, Glomerular Filtration Rate, Humans, New England, Renal Insufficiency, Chronic
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