• Salman Ahmed, Cameron T Nutt, Nwamaka D Eneanya, Peter P Reese, Karthik Sivashanker, Michelle Morse, Thomas Sequist, and Mallika L Mendu.
• Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. sahmed28@bwh.harvard.edu.
• J Gen Intern Med. 2021 Feb 1; 36 (2): 464471464-471.

BackgroundAdvancing health equity entails reducing disparities in care. African-American patients with chronic kidney disease (CKD) have poorer outcomes, including dialysis access placement and transplantation. Estimated glomerular filtration rate (eGFR) equations, which assign higher eGFR values to African-American patients, may be a mechanism for inequitable outcomes. Electronic health record-based registries enable population-based examination of care across racial groups.ObjectiveTo examine the impact of the race multiplier for African-Americans in the CKD-EPI eGFR equation on CKD classification and care delivery.DesignCross-sectional study SETTING: Two large academic medical centers and affiliated community primary care and specialty practices.ParticipantsA total of 56,845 patients in the Partners HealthCare System CKD registry in June 2019, among whom 2225 (3.9%) were African-American.MeasurementsExposures included race, age, sex, comorbidities, and eGFR. Outcomes were transplant referral and dialysis access placement.ResultsOf 2225 African-American patients, 743 (33.4%) would hypothetically be reclassified to a more severe CKD stage if the race multiplier were removed from the CKD-EPI equation. Similarly, 167 of 687 (24.3%) would be reclassified from stage 3B to stage 4. Finally, 64 of 2069 patients (3.1%) would be reassigned from eGFR > 20 ml/min/1.73 m2 to eGFR ≤ 20 ml/min/1.73 m2, meeting the criterion for accumulating kidney transplant priority. Zero of 64 African-American patients with an eGFR ≤ 20 ml/min/1.73 m2 after the race multiplier was removed were referred, evaluated, or waitlisted for kidney transplant, compared to 19.2% of African-American patients with eGFR ≤ 20 ml/min/1.73 m2 with the default CKD-EPI equation.LimitationsSingle healthcare system in the Northeastern United States and relatively small African-American patient cohort may limit generalizability.ConclusionsOur study reveals a meaningful impact of race-adjusted eGFR on the care provided to the African-American CKD patient population.

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