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Cited by 241Chronic Kidney Disease and DiabetesRace, Genetics, and SocietyDialysis and Renal Disease Management

Race, genetic ancestry, and estimating kidney function in CKD

Open access
Hsu, Chi-yuan, Yang, Wei, Parikh, Rishi V., Anderson, Amanda H., Chen, Teresa K., Cohen, Debbie L., He, Jiang, Mohanty, Madhumita J. +13 more·2021·New England Journal of Medicine
DOI 10.1056/nejmoa2103753PMC PMC8994696
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Abstract

BACKGROUND: The inclusion of race in equations to estimate the glomerular filtration rate (GFR) has become controversial. Alternative equations that can be used to achieve similar accuracy without the use of race are needed. METHODS: In a large national study involving adults with chronic kidney disease, we conducted cross-sectional analyses of baseline data from 1248 participants for whom data, including the following, had been collected: race as reported by the participant, genetic ancestry markers, and the serum creatinine, serum cystatin C, and 24-hour urinary creatinine levels. RESULTS: , 41%; 95% CI, 34 to 49) estimates in Black participants when GFR was estimated with the use of cystatin C. CONCLUSIONS: The use of the serum creatinine level to estimate the GFR without race (or genetic ancestry) introduced systematic misclassification that could not be eliminated even when numerous non-GFR determinants of the serum creatinine level were accounted for. The estimation of GFR with the use of cystatin C generated similar results while eliminating the negative consequences of the current race-based approaches. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).

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  • Another CKD-EPI equation that additionally incorporates serum cystatin C increases precision and reduces racial and ethnic bias.

    “Another CKD-EPI equation that additionally incorporates serum cystatin C increases precision and reduces racial and ethnic bias, offering additional value in screening and for confirmation of low eGFR in appropriate cases (23–25).”

    From Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (2022) · cites this paper as [24]

    The Results (Use of Cystatin C to Estimate GFR; page unavailable) and Discussion report that cystatin C–based estimates did not require race or ancestry terms and had precision similar to creatinine-based estimates. The paper studied cystatin C as an alternative to creatinine, not an additional marker in a CKD-EPI equation; it does not establish increased precision, reduced bias across ethnic groups, or the claimed screening and confirmation benefits. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

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References 31 · Cited by 241

Research works printed but not linked: 26

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Authors
Hsu, C.-Y., Yang, W., Parikh, R. V., Anderson, A. H., Chen, T. K., Cohen, D. L., He, J., Mohanty, M. J., Lash, J. P., Mills, K. T., Muiru, A. N., Parsa, A., Saunders, M. R., Shafi, T., Townsend, R. R., Waikar, S. S., Wang, J., Wolf, M., Tan, T. C., Feldman, H. I., & Go, A. S.
Affiliations
University of California, San Francisco (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2021-11-04
Volume
385
Issue
19
Pages
1750-1760
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa2103753
PMC
PMC8994696
OpenAlex
W3200414192
Cited by
241
References
31
Citations by year
2026: 26 · 2025: 34 · 2024: 42 · 2023: 69 · 2022: 59 · 2021: 9
FWCI
30.66
Type
journal article
Language
en
Open access
Licence
www.nejmgroup.org/legal/terms-of-use.htm (vor)
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK119199, U01DK060902, U01DK060963, U01DK060980, U01DK060984, U01DK060990, U01DK061021, U01DK061022, U01DK061028, U24DK060990)
  • National Center for Advancing Translational Sciences (M01RR16500, P20GM109036, UL1RR024131, UL1RR029879, UL1TR000003, UL1TR000424, UL1TR000433, UL1TR000439)
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
chronic kidney disease, glomerular filtration rate estimation, genetic ancestry, cystatin C, serum creatinine, Black patients, misclassification, renal function
MeSH terms
Adult, Aged, Algorithms, Black or African American, Creatinine, Cross-Sectional Studies, Ethnicity, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, United States, Black People, Racial Groups, Renal Insufficiency, Chronic, Cystatin C

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