Is race adjustment necessary to estimate glomerular filtration rate in South Brazilians?

• Published in: Journal of nephrology 2024-12, Vol.37 (9), p.2635-2645
• Main Authors: Escott, Gustavo Monteiro, Zingano, Carolina Pires, Ferlin, Elton, Garroni, Marcelo, Thomé, Fernando S., Veronese, Francisco José Veríssimo, Silveiro, Sandra Pinho
• Format: Article
• Language: English
• Subjects: Adult; Aged; Black People; Brazil - epidemiology; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - ethnology; Diabetes Mellitus, Type 2 - physiopathology; Female; Glomerular Filtration Rate; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Original Article; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - ethnology; Renal Insufficiency, Chronic - physiopathology; Reproducibility of Results; South American People; Urology; White People
• ISSN: 1724-6059; 1724-6059
• DOI: 10.1007/s40620-024-02001-x

Background and aims Race coefficients (RC) in equations to estimate glomerular filtration rate (GFR) have been highly questioned. We aimed to evaluate the performance of three equations, namely 2009 Chronic Kidney Disease Epidemiology Collaboration (2009 CKD-EPI), 2021 CKD-EPI, and European Kidney Function Consortium (EKFC) in self-reported Black and White Brazilians. Materials and methods Our cross-sectional study compared estimated GFR (eGFR) with 51 Cr-EDTA measured GFR (mGFR) in healthy adults, patients with type 2 diabetes mellitus with or without chronic kidney disease (CKD), and in non-diabetic individuals with CKD. The performance of these equations was assessed using Bland–Altman plots, Lin’s concordance correlation coefficient (CCC), bias, P30, and P15 accuracy. Results Three hundred six White adults (aged 53 ± 17 years, 55% women, mean mGFR: 83 ± 32 mL/min/1.73 m 2 ) and 48 Black participants (aged 53 ± 17 years, 58% women, mGFR: 90 ± 34 mL/min/1.73 m 2 ) were included. No equation achieved the desirable P30 accuracy value of 90%, neither in White (2009 CKD-EPI:78%, 2021 CKD-EPI:76% and EKFC:77%, p  = 0.368) nor in Black volunteers (respective values of 77%, 75%, and 77%; p  = 0.882). The 2009 CKD-EPI showed the best performance in Black participants (bias: 4.04; CCC: 0.848), whereas the 2021 CKD-EPI performed better in Whites, with smaller bias (1.45), and better concordance correlation coefficient (0.790). The EKFC presented the worst performance. All equations underdiagnosed advanced CKD in White participants, but not in Black. Conclusions The 2021 CKD-EPI does not outperform the 2009 CKD-EPI. Instead, it underestimated the occurrence of CKD in White participants. Thus, we do not recommend replacing the 2009 with the new 2021 CKD-EPI in the Brazilian population. Graphical abstract