Commentary

The new GFR equations: How will eliminating the race coefficient affect Black patients?

Paul Merchant, MD, Crystal Gadegbeku, MD, FAHA, FACP, FASN, Ali Mehdi, MD, Med, FACP, FASN, George Thomas, MD, FACP, Georges Nakhoul, MD, MEd and Jonathan Taliercio, DO, FASN
Cleveland Clinic Journal of Medicine November 2023, 90 (11) 685-691; DOI: https://doi.org/10.3949/ccjm.90a.22061

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  • TABLE 1

    Non-GFR determinants of creatinine and cystatin C

    Increase serum creatinine concentration
    Muscle mass
    Protein intake
    Rhabdomyolysis
    Increase serum cystatin C
    Male
    Older age
    Obesity
    Smoking
    Hyperthyroidism (hypothyroidism decreases it)
    Glucocorticoid therapy
    Inflammatory markers (C-reactive protein)
    Malignancy
    Consider ordering serum cystatin C GFR
    In patients at the extremes of muscle mass or cachexia
    When the serum creatinine concentration is elevated without urinary or radiologic evidence of kidney damage
    When a more precise GFR measurement will change treatment decisions

    • GFR = glomerular filtration rate

  • TABLE 2

    Potential patient impacts of the 2021 CKD-EPI equations

    Positive impacts
    Earlier nephrology referral for Black patients
    Earlier recognition and treatment of chronic kidney disease in Black patients
    Earlier referral for transplant evaluation
    Increased patient trust in the healthcare system
    Negative impacts
    Exclusion of medications restricted by GFR cutoff (eg, metformin, sodium-glucose cotransporter 2 inhibitors, and some chemotherapy agents)
    Dose reductions of critical medications (eg, antibiotics, antivirals, and some chemotherapy)
    Exclusion from clinical trials or organ donation based on chronic kidney disease, chronic kidney disease stage, or GFR cutoff
    Substandard imaging due to avoidance or reduction of contrast use
    Increased medical insurance, life insurance costs
    Increased patient anxiety from the diagnosis
    Neutral or unclear impacts
    Reclassification of chronic kidney disease stage
    Changes in estimates of prevalence of chronic kidney disease

    • CKD-EPI = Chronic Kidney Disease Epidemiology Collaboration study; GFR = glomerular filtration rate

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