Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018
Open accessAbstract
BACKGROUND: guide kidney disease management. Racialized adjustment of eGFR in Black Americans may thereby affect their clinical care. In this study, we analyze and extrapolate national data to assess potential impacts of the eGFR race adjustment on qualification for kidney disease diagnosis, nephrologist referral, and transplantation listing. METHODS: Using population-representative cross-sectional data from the United States National Health and Nutrition Examination Survey (NHANES) from 2015-2018, eGFR values for Black Americans were calculated using the Modification of Diet in Renal Disease (MDRD) equation with and without the 1.21 race-specific coefficient using cohort data on age, sex, race, and serum creatinine. FINDINGS: Without the MDRD eGFR race adjustment, 3.3 million (10.4%) more Black Americans would reach a diagnostic threshold for Stage 3 Chronic Kidney Disease, 300,000 (0.7%) more would qualify for beneficial nephrologist referral, and 31,000 (0.1%) more would become eligible for transplant evaluation and waitlist inclusion. INTERPRETATION: These findings suggest eGFR race coefficients may contribute to racial differences in the management of kidney. We provide recommendations for addressing this issue at institutional and individual levels. FUNDING: No external funding was received for this study.
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Race-based medicine has been identified as a contributor to racial health disparities in the United States.
“race-based medicine has been identified as a contributor to racial health disparities in the United States 29”
From Challenging Race-Based Medicine Through Historical Education About the Social Construction of Race (2023) · cites this paper as [29]
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AlKetbi, L. B., Boobes, Y. A. R., Afandi, B. O., Aleissaee, H., AlShamsi, N., AlMansoori, M., Hemaid, A., AlDobaee, M., AlAlawi, N., AlKetbi, R. M., et al. (2025) · Journal of Nephrology · doi:10.1007/s40620-025-02347-w
Larkin, C. T., Seegmiller, J. C., Yang, P. O., Ricardo, A. C., Alvarez, D. S., Kramer, H., Johns, T. S., Daviglus, M. L., Franceschini, N., & Lash, J. P. (2025) · Kidney Medicine · doi:10.1016/j.xkme.2025.101097
Visualizing Racial Diversity in Anatomy Curricula Entrenches “Race” as a Biological Phenomenon
Jacobs, D. S. (2026) · Biomedical visualization · doi:10.1007/978-3-032-12305-3_3
Upstream from Urosepsis: Removing Race from Pediatric Urinary Tract Infection Algorithms
Weaver, M. S., Johnson, L., Williams, A., Cohen, A. S., & Pecker, L. H. (2026) · The American Journal of Bioethics · doi:10.1080/15265161.2025.2608647
Racial/ethnic inequities in diabetes mellitus: a narrative review
Mazhude, T., Fanas, R. L., & Myers, A. K. (2026) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgag277
Home blood pressure telemonitoring reveals race-specific patterns of target organ damage
Zhang, D., An, D., Yu, Y., Kaleta, B. P., Mokwatsi, G. G., Martens, D. S., Abiodun, O. O., Anya, T., Kruger, R., Isiguzo, G. C., et al. (2026) · Journal of Hypertension · doi:10.1097/hjh.0000000000004390
Troutt, D. D. (2026) · doi:10.1017/9781009707374.011
- Authors
- Tsai, J. W., Cerdeña, J. P., Goedel, W. C., Asch, W. S., Grubbs, V., Mendu, M. L., & Kaufman, J. S.
- Affiliations
- Yale University (US)
- Brown University (US)
- University of California, San Francisco (US)
- Brigham and Women's Hospital (US)
- McGill University (CA)
- Corresponding author
- Tsai, Jennifer W.
- ORCID
- Venue
- eClinicalMedicine
- Publisher
- Elsevier BV
- Published
- 2021-12
- Volume
- 42
- Pages
- 101197
- ISSN
- 2589-5370 (ISSN-L)
- PMC
- PMC8608882
- OpenAlex
- W3217072506
- Cited by
- 58
- References
- 43
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 22 · 2023: 13 · 2022: 13
- FWCI
- 8.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- EClinicalMedicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health (UL1TR001863)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Race, Genetics, and Society
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Keywords
- estimated glomerular filtration rate, African Americans, chronic kidney disease diagnosis, nephrology referral, MDRD equation, serum creatinine, NHANES
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