Transplant Clinician Opinions on Use of Race in the Estimation of Glomerular Filtration Rate. Clin J Am Soc Nephrol 2021 Oct;16(10):1552-1559
Date
10/09/2021Pubmed ID
34620650Pubmed Central ID
PMC8499001DOI
10.2215/CJN.05490421Scopus ID
2-s2.0-85117074678 (requires institutional sign-in at Scopus site) 12 CitationsAbstract
BACKGROUND AND OBJECTIVES: Current race-based eGFR calculators assign a higher eGFR value to Black patients, which could affect the care of kidney transplant candidates and potential living donors.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a survey of staff at adult kidney transplant centers in the United States (December 17, 2020 to February 28, 2021) to assess opinions on use of race-based eGFR equations for waitlisting and living donor candidate evaluation, availability of serum cystatin C testing and measured GFR, and related practices.
RESULTS: Respondents represented 57% (124 of 218) of adult kidney transplant programs, and the responding centers conducted 70% of recent kidney transplant volume. Most (93%) programs use serum creatinine-based eGFR for listing candidates. However, only 6% of respondents felt that current race-based eGFR calculators are appropriate, with desire for change grounded in concerns for promotion of health care disparities by current equations and inaccuracies in reporting of race. Most respondents (70%) believed that elimination of race would allow more preemptive waitlisting for Black patients, but a majority (79%) also raised concerns that such an approach could incur harms. More than one third of the responding programs lacked or were unsure of availability of testing for cystatin C or measured GFR. At this time, 40% of represented centers did not plan to remove race from eGFR calculators, 46% were planning to remove, and 15% had already done so. There was substantial variability in eGFR reporting and listing of multiracial patients with some Black ancestry. There was no difference in GFR acceptance thresholds for Black versus non-Black living donors.
CONCLUSIONS: This national survey highlights a broad consensus that extant approaches to GFR estimation are unsatisfactory, but it also identified a range of current opinions.
Author List
Doshi MD, Singh N, Hippen BE, Woodside KJ, Mohan P, Byford HL, Cooper M, Dadhania DM, Ainapurapu S, Lentine KLAuthor
Matthew Cooper MD Chief, Director, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Attitude of Health PersonnelDecision Support Techniques
Donor Selection
Glomerular Filtration Rate
Health Care Surveys
Humans
Kidney
Kidney Diseases
Kidney Transplantation
Living Donors
Models, Biological
Predictive Value of Tests
Risk Assessment
Risk Factors
United States
Waiting Lists
