Journal Article

Estimated glomerular filtration rate equations in people of self-reported black ethnicity in the United Kingdom: Inappropriate adjustment for ethnicity may lead to reduced access to care

Sharpe, Claire C., Vincent, Royce P., Bramham, Kate, Heraghty, Neil, Gama, Rouvick M., Griffiths, Kathryn, Cairns, Hugh, Clery, Amanda, Palmer, Kieran, Peters, Adrien M., Kibble, Henry

2021

Overview

Assessment in African populations suggest adjustment for ethnicity in estimated glomerular filtration rate (eGFR) equations derived from African Americans lead to overestimation of GFR and failure to determine severity in chronic kidney disease (CKD). However, studies in African Europeans are limited. We aimed to assess accuracy of eGFR equations, with and without ethnicity adjustment compared with measured GFR in people of Black ethnicity in the United Kingdom. Performance of MDRD, CKD-EPI (with and without ethnicity adjustment), Full Age Spectrum (FAS), revised Lund Malmö (LM Revised), and European Kidney Function Consortium (EKFC) eGFR equations were assessed compared to 51 Cr-EDTA GFR studies extracted from hospital databases. Participants with albumin <30g/l, liver disease, <18 years, of non-Black or non-White self-reported ethnicity were excluded. Agreement was assessed by bias, precision and 30%-accuracy and was stratified for ethnicity and GFR. 1888 51 Cr-EDTA studies were included (Mean age-53.7yrs; 43.6% female; 14.1% Black ethnicity). Compared to White participants, eGFR-MDRD and eGFR-CKD-EPI equations in Black participants significantly overestimated GFR (bias 20.3 and 19.7 ml/min/1.73m 2 respectively, p<0.001). Disregarding the ethnicity adjustment significantly improved GFR estimates for Black participants (bias 6.7 and 2.4ml/min/1.73m 2 for eGFR-MDRD and eGFR-CKD-EPI respectively, p<0.001). The LM Revised equation had the smallest bias for both White and Black participants (5.8ml and -1.1ml/min/1.73m 2 respectively). 30%-accuracy was superior for GFR≥60ml/min/1.73m 2 compared to <60ml/min/1.73m 2 using eGFR-CKD-EPI equation for both White and Black participants (p<0.001). Multivariate regression methodology with adjustment for age, sex and log(serum creatinine) in the cohort yielded an ethnicity coefficient of 1.018 (95% CI: 1.009–1.027). Overestimation of measured GFR with eGFR equations using ethnicity adjustment factors may lead to reduced CKD diagnosis and under-recognition of severity in people of Black ethnicity. Our findings suggest that ethnicity adjustment for GFR estimation in non-African Americans may not be appropriate for use in people of Black ethnicity in the UK.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Accuracy / Adult / Age / Aged / Agreements / Albumins / Algorithms / Bias / Biology and Life Sciences / Black or African American / Black People / Blacks / Chromium radioisotopes / Chronic kidney failure / Collaboration / Consortia / Creatinine / Creatinine - blood / Cross-Sectional Studies / Databases, Factual / Demographic aspects / Diagnosis / Edetic acid / Epidemiology / Epidermal growth factor receptors / Ethnicity / Ethylenediaminetetraacetic acids / Female / Glomerular filtration rate / Glomerular Filtration Rate - physiology / Health aspects / Health care access / Hospitals / Humans / Kidney diseases / Kidneys / Laboratories / Linear Models / Liver diseases / Male / Mathematical analysis / Medicine and Health Sciences / Middle Aged / Minority & ethnic groups / Nephrology / Nuclear medicine / Odds Ratio / People and Places / Renal Insufficiency, Chronic - ethnology / Renal Insufficiency, Chronic - physiopathology / Renal replacement therapy / Self Report / United Kingdom / Variables / White People