CoChat
Sign Up
Cited by 19Chronic Kidney Disease and DiabetesClinical Laboratory Practices and Quality ControlRace, Genetics, and Society

Limited evidence for use of a black race modifier in eGFR calculations: a systematic review

Open access
Marzinke, Mark A, Greene, Dina N, Bossuyt, Patrick M, Chambliss, Allison B, Cirrincione, Lauren R, McCudden, Christopher R, Melanson, Stacy E F, Noguez, Jaime H +6 more·2022·Clinical Chemistry
DOI 10.1093/clinchem/hvab279
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: Commonly used estimated glomerular filtration rate (eGFR) equations include a Black race modifier (BRM) that was incorporated during equation derivation. Race is a social construct, and a poorly characterized variable that is applied inconsistently in clinical settings. The BRM results in higher eGFR for any creatinine concentration, implying fundamental differences in creatinine production or excretion in Black individuals compared to other populations. Equations without inclusion of the BRM have the potential to detect kidney disease earlier in patients at the greatest risk of chronic kidney disease (CKD), but also has the potential to over-diagnose CKD or impact downstream clinical interventions. The purpose of this study was to use an evidence-based approach to systematically evaluate the literature relevant to the performance of the eGFR equations with and without the BRM and to examine the clinical impact of the use or removal. Content: PubMed and Embase databases were searched for studies comparing measured GFR to eGFR in racially diverse adult populations using the Modification of Diet in Renal Disease or the 2009-Chronic Kidney Disease Epidemiology Collaboration-creatinine equations based on standardized creatinine measurements. Additionally, we searched for studies comparing clinical use of eGFR calculated with and without the BRM. Here, 8632 unique publications were identified; an additional 3 studies were added post hoc. In total, 96 studies were subjected to further analysis and 44 studies were used to make a final assessment. Summary: There is limited published evidence to support the use of a BRM in eGFR equations.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1093/clinchem/hvab279

Cites

59 of 59 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Using race as a factor leads to overestimation of kidney function in black patients.

    “Using race as a factor leads to overestimation of kidney function in black patients, potentially leading to longer times to get on kidney transplant lists [92–95].”

    From Bias in medical AI: Implications for clinical decision-making (2024) · cites this paper as [92]

  • There is limited evidence for using black race as a factor for calculating estimated glomerular filtration rate.

    “For example, there is limited evidence for using black race as a factor for calculating estimated glomerular filtration rate, a critical measure of kidney function [92].”

    From Bias in medical AI: Implications for clinical decision-making (2024) · cites this paper as [92]

  • There are well-documented instances of insufficient evidence for race and ethnicity to be used as predictive factors in models.

    “There are several well-documented instances of insufficient evidence for race and ethnicity to be used as predictive factors in models.”

    From Bias in medical AI: Implications for clinical decision-making (2024) · cites this paper as [92]

  • Overestimation of kidney function in black patients potentially leads to longer times to get on kidney transplant lists.

    “Using race as a factor leads to overestimation of kidney function in black patients, potentially leading to longer times to get on kidney transplant lists [92–95].”

    From Bias in medical AI: Implications for clinical decision-making (2024) · cites this paper as [92]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 46

  1. Chapter 1: Definition and classification of CKD. Kidney Int Suppl (2011). Jan 2013;3(1):19-62. doi:10.1038/kisup.2012. · DOI
  2. Norris KC, Eneanya ND, Boulware LE. Removal of Race From Estimates of Kidney Function: First, Do No Harm. JAMA. 01 2021;325(2):135-137. doi:10.1001/jama.2020.23373 · DOI
  3. Nóbrega AM, Gomes CP, Lemos CC, Bregman R. Is it possible to use modification of diet in renal disease (MDRD) equation in a Brazilian population? J Nephrol. 2006 Mar-Apr 2006;19(2):196-9.
  4. le Riche M, Zemlin AE, Erasmus RT, Davids MR. An audit of 24-hour creatinine clearance measurements at Tygerberg Hospital and comparison with prediction equations. S Afr Med J. Oct 2007;97(10):968-70.
  5. Eastwood JB, Kerry SM, Plange-Rhule J, et al. Assessment of GFR by four methods in adults in Ashanti, Ghana: the need for an eGFR equation for lean African populations. Nephrol Dial Transplant. Jul 2010;25(7):2178-87. doi:10.1093/ndt/gfp765 · DOI
  6. Wyatt CM, Shi Q, Novak JE, et al. Prevalence of kidney disease in HIV-infected and uninfected Rwandan women. PLoS One. Mar 28 2011;6(3):e18352. doi:10.1371/journal.pone.0018352 · DOI
  7. Matsha TE, Yako YY, Rensburg MA, Hassan MS, Kengne AP, Erasmus RT. Chronic kidney diseases in mixed ancestry south African populations: prevalence, determinants and concordance between kidney function estimators. BMC Nephrol. Apr 02 2013;14:75. doi:10.1186/1471-2369-14-75 · DOI
  8. Barcellos RC, Matos JP, Kang HC, Rosa ML, Lugon JR. Comparison of serum creatinine levels in different color/race categories in a Brazilian population. Cad Saude Publica. Jul 2015;31(7):1565-9. doi:10.1590/0102-311X00150814 · DOI
  9. Agoons DD, Balti EV, Kaze FF, et al. Performance of three glomerular filtration rate estimation equations in a population of sub-Saharan Africans with Type 2 diabetes. Diabet Med. 09 2016;33(9):1291-8. doi:10.1111/dme.12996 · DOI
  10. Omuse G, Maina D, Mwangi J, et al. Comparison of equations for estimating glomerular filtration rate in screening for chronic kidney disease in asymptomatic black Africans: a cross sectional study. BMC Nephrol. Dec 20 2017;18(1):369. doi:10.1186/s12882-017-0788-y · DOI
  11. Yilma D, Abdissa A, Kæstel P, et al. Serum creatinine and estimated glomerular filtration rates in HIV positive and negative adults in Ethiopia. PLoS One. 2019;14(2):e0211630. doi:10.1371/journal.pone.0211630 · DOI
  12. Stöhr W, Walker AS, Munderi P, et al. Estimating glomerular filtration rate in HIV-infected adults in Africa: comparison of Cockcroft-Gault and Modification of Diet in Renal Disease formulae. Antivir Ther. 2008;13(6):761-70.
  13. Abefe SA, Abiola AF, Olubunmi AA, Adewale A. Utility of predicted creatinine clearance using MDRD formula compared with other predictive formulas in Nigerian patients. Saudi J Kidney Dis Transpl. Jan 2009;20(1):86-90.
  14. Longo AL, Lepira FB, Sumaili EK, et al. Prevalence of low estimated glomerular filtration rate, proteinuria, and associated risk factors among HIV-infected black patients using Cockroft-Gault and modification of diet in renal disease study equations. J Acquir Immune Defic Syndr. Jan 01 2012;59(1):59-64. doi:10.1097/QAI.0b013e31823587b0 · DOI
  15. Booysen HL, Woodiwiss AJ, Raymond A, et al. Chronic kidney disease epidemiology collaboration-derived glomerular filtration rate performs better at detecting preclinical end-organ changes than alternative equations in black Africans. J Hypertens. 06 2016;34(6):1178-85. doi:10.1097/HJH.0000000000000924 · DOI
  16. Kalyesubula R, Hau JP, Asiki G, et al. Impaired renal function in a rural Ugandan population cohort. Wellcome Open Res. 2018;3:149. doi:10.12688/wellcomeopenres.14863. · DOI
  17. Peer N, George J, Lombard C, Steyn K, Levitt N, Kengne AP. Prevalence, concordance and associations of chronic kidney disease by five estimators in South Africa. BMC Nephrol. 08 27 2020;21(1):372. doi:10.1186/s12882-020-02018-x · DOI
  18. Masimango MI, Sumaili EK, Wallemacq P, et al. Prevalence and Risk Factors of CKD in South Kivu, Democratic Republic of Congo: A Large- Scale Population Study. Kidney Int Rep. Aug 2020;5(8):1251-1260. doi:10.1016/j.ekir.2020.05.028 · DOI
  19. Muiru AN, Charlebois ED, Balzer LB, et al. The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study. PLoS One. 2020;15(3):e0229649. doi:10.1371/journal.pone.0229649 · DOI
  20. Haas Pizarro M, Conte Santos D, Gomes Nunes Melo L, et al. Glomerular filtration rate estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in type 1 diabetes based on genomic ancestry. Diabetol Metab Syndr. 2020;12:71. doi:10.1186/s13098-020-00578-4 · DOI
  21. Ward MM. Laboratory abnormalities at the onset of treatment of end-stage renal disease: are there racial or socioeconomic disparities in care? Arch Intern Med. May 28 2007;167(10):1083-91. doi:10.1001/archinte.167.10.1083 · DOI
  22. Kramer H, Palmas W, Kestenbaum B, et al. Chronic kidney disease prevalence estimates among racial/ethnic groups: the Multi-Ethnic Study of Atherosclerosis. Clin J Am Soc Nephrol. Sep 2008;3(5):1391-7. doi:10.2215/CJN.04160907 · DOI
  23. Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. May 2014;63(5):713-35. doi:10.1053/j.ajkd.2014.01.416 · DOI
  24. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. May 2009;150(9):604-12. doi:10.7326/0003-4819-150-9-200905050-00006 · DOI · Paper page
  25. Stevens LA, Schmid CH, Zhang YL, et al. Development and validation of GFR-estimating equations using diabetes, transplant and weight. Nephrol Dial Transplant. Feb 2010;25(2):449-57. doi:10.1093/ndt/gfp510 · DOI
  26. Alves TP, Hulgan T, Wu P, et al. Race, kidney disease progression, and mortality risk in HIV-infected persons. Clin J Am Soc Nephrol. Dec 2010;5(12):2269-75. doi:10.2215/CJN.00520110 · DOI
  27. Matsushita K, Selvin E, Bash LD, Astor BC, Coresh J. Risk implications of the new CKD Epidemiology Collaboration (CKD-EPI) equation compared with the MDRD Study equation for estimated GFR: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis. Apr 2010;55(4):648-59. doi:10.1053/j.ajkd.2009.12.016 · DOI
  28. de Lusignan S, Tomson C, Harris K, van Vlymen J, Gallagher H. Creatinine fluctuation has a greater effect than the formula to estimate glomerular filtration rate on the prevalence of chronic kidney disease. Nephron Clin Pract. 2011;117(3):c213-24. doi:10.1159/000320341 · DOI
  29. Stevens LA, Claybon MA, Schmid CH, et al. Evaluation of the Chronic Kidney Disease Epidemiology Collaboration equation for estimating the glomerular filtration rate in multiple ethnicities. Kidney Int. Mar 2011;79(5):555-62. doi:10.1038/ki.2010.462 · DOI
  30. Wetmore JB, Sankaran S, Jones PG, Reid KJ, Spertus JA. Association of decreased glomerular filtration rate with racial differences in survival after acute myocardial infarction. Clin J Am Soc Nephrol. Apr 2011;6(4):733-40. doi:10.2215/CJN.02030310 · DOI
  31. Arora P, Rajagopalan S, Patel N, Nainani N, Venuto RC, Lohr JW. The MDRD equation underestimates the prevalence of CKD among blacks and overestimates the prevalence of CKD among whites compared to the CKD-EPI equation: a retrospective cohort study. BMC Nephrol. Jan 2012;13:4. doi:10.1186/1471-2369-13-4 · DOI
  32. Matsushita K, Mahmoodi BK, Woodward M, et al. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. JAMA. May 09 2012;307(18):1941-51. doi:10.1001/jama.2012.3954 · DOI
  33. Muntner P, Newsome B, Kramer H, et al. Racial differences in the incidence of chronic kidney disease. Clin J Am Soc Nephrol. Jan 2012;7(1):101-7. doi:10.2215/CJN.06450611 · DOI
  34. Park M, Shlipak MG, Katz R, et al. Subclinical cardiac abnormalities and kidney function decline: the multi-ethnic study of atherosclerosis. Clin J Am Soc Nephrol. Jul 2012;7(7):1137-44. doi:10.2215/CJN.01230212 · DOI
  35. Pottel H, Hoste L, Delanaye P, Cavalier E, Martens F. Demystifying ethnic/sex differences in kidney function: is the difference in (estimating) glomerular filtration rate or in serum creatinine concentration? Clin Chim Acta. Oct 09 2012;413(19-20):1612-7. doi:10.1016/j.cca.2012.04.034 · DOI
  36. Jolly SE, Navaneethan SD, Schold JD, et al. Chronic kidney disease in an electronic health record problem list: quality of care, ESRD, and mortality. Am J Nephrol. 2014;39(4):288-96. doi:10.1159/000360306 · DOI
  37. Margolick JB, Jacobson LP, Schwartz GJ, et al. Factors affecting glomerular filtration rate, as measured by iohexol disappearance, in men with or at risk for HIV infection. PLoS One. 2014;9(2):e86311. doi:10.1371/journal.pone.0086311 · DOI
  38. Wong MG, Pollock CA, Cooper BA, et al. Association between GFR estimated by multiple methods at dialysis commencement and patient survival. Clin J Am Soc Nephrol. Jan 2014;9(1):135-42. doi:10.2215/CJN.02310213 · DOI
  39. Mariante-Neto G, Brandão AB. Model for End-Stage Liver Disease: Is Sex-Based Creatinine Correction a Viable Strategy for Black Females? Transplantation. Nov 2015;99(11):2337-40. doi:10.1097/TP.0000000000000747 · DOI
  40. Tuot DS, Lin F, Shlipak MG, et al. Potential Impact of Prescribing Metformin According to eGFR Rather Than Serum Creatinine. Diabetes Care. Nov 2015;38(11):2059-67. doi:10.2337/dc15-0542 · DOI
  41. Inker LA, Shafi T, Okparavero A, et al. Effects of Race and Sex on Measured GFR: The Multi-Ethnic Study of Atherosclerosis. Am J Kidney Dis. Nov 2016;68(5):743-751. doi:10.1053/j.ajkd.2016.06.021 · DOI
  42. Rocco MV, Chapman A, Chertow GM, et al. Chronic Kidney Disease Classification in Systolic Blood Pressure Intervention Trial: Comparison Using Modification of Diet in Renal Disease and CKD-Epidemiology Collaboration Definitions. Am J Nephrol. 2016;44(2):130-40. doi:10.1159/000448722 · DOI
  43. Rebholz CM, Inker LA, Chen Y, et al. Risk of ESRD and Mortality Associated With Change in Filtration Markers. Am J Kidney Dis. Oct 2017;70(4):551-560. doi:10.1053/j.ajkd.2017.04.025 · DOI
  44. Nelson RG, Grams ME, Ballew SH, et al. Development of Risk Prediction Equations for Incident Chronic Kidney Disease. JAMA. 12 03 2019;322(21):2104-2114. doi:10.1001/jama.2019.17379 · DOI
  45. Shin JI, Sang Y, Chang AR, et al. The FDA Metformin Label Change and Racial and Sex Disparities in Metformin Prescription among Patients with CKD. J Am Soc Nephrol. 08 2020;31(8):1847-1858. doi:10.1681/ASN.2019101119 · DOI
  46. Willey JZ, Moon YP, Husain SA, et al. Creatinine versus cystatin C for renal function-based mortality prediction in an elderly cohort: The Northern Manhattan Study. PLoS One. 2020;15(1):e0226509. doi:10.1371/journal.pone.0226509 · DOI

Cited by

Sorted by citations

Related

Authors
Marzinke, M. A., Greene, D. N., Bossuyt, P. M., Chambliss, A. B., Cirrincione, L. R., McCudden, C. R., Melanson, S. E. F., Noguez, J. H., Patel, K., Radix, A. E., Takwoingi, Y., Winston-McPherson, G., Young, B. A., & Hoenig, M. P.
Affiliations
  • Johns Hopkins University (US)
  • University of Washington (US)
  • Amsterdam University Medical Centers (NL)
  • University of Southern California (US)
  • University of Ottawa (CA)
  • Brigham and Women's Hospital (US)
  • University Hospitals of Cleveland (US)
  • University of Pennsylvania (US)
  • University Hospitals Birmingham NHS Foundation Trust (GB)
  • Henry Ford Health (US)
  • Office of Healthcare Equity, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
  • Beth Israel Deaconess Medical Center (US)
Corresponding author
Hoenig, Melanie P
ORCID
Venue
Clinical Chemistry
Publisher
Oxford University Press (OUP)
Published
2021-12-20
Volume
68
Issue
4
Pages
521-533
ISSN
  • 0009-9147 (ISSN-L)
  • 1530-8561
DOI
10.1093/clinchem/hvab279
OpenAlex
W4200061700
Cited by
19
References
59
Citations by year
2026: 2 · 2025: 1 · 2024: 6 · 2023: 8 · 2022: 2
FWCI
0.65
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Chemistry (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
Funders
  • M.A. Marzinke, the National Institute of Health (NIH), Merck, Gilead Biosciences, Viiv/GSK, HPTN
  • B.A. Young, the NIH, the Chow Foundation, and the Kuni Foundation
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Race, Genetics, and Society
Keywords
estimated glomerular filtration rate, eGFR equations, chronic kidney disease, MDRD equation, CKD-EPI equation, creatinine
MeSH terms
Adult, Creatinine, Diet, Glomerular Filtration Rate, Humans, Black People, Renal Insufficiency, Chronic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review