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Pierre CC, Marzinke MA, Ahmed SB, Collister D, Colón-Franco JM, Hoenig MP, Lorey T, Palevsky PM, Palmer OP, Rosas SE, Vassalotti J, Whitley CT, Greene DN. AACC/NKF Guidance Document on Improving Equity in Chronic Kidney Disease Care. J Appl Lab Med 2023:jfad022. [PMID: 37379065 DOI: 10.1093/jalm/jfad022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Kidney disease (KD) is an important health equity issue with Black, Hispanic, and socioeconomically disadvantaged individuals experiencing a disproportionate disease burden. Prior to 2021, the commonly used estimated glomerular filtration rate (eGFR) equations incorporated coefficients for Black race that conferred higher GFR estimates for Black individuals compared to non-Black individuals of the same sex, age, and blood creatinine concentration. With a recognition that race does not delineate distinct biological categories, a joint task force of the National Kidney Foundation and the American Society of Nephrology recommended the adoption of the CKD-EPI 2021 race-agnostic equations. CONTENT This document provides guidance on implementation of the CKD-EPI 2021 equations. It describes recommendations for KD biomarker testing, and opportunities for collaboration between clinical laboratories and providers to improve KD detection in high-risk populations. Further, the document provides guidance on the use of cystatin C, and eGFR reporting and interpretation in gender-diverse populations. SUMMARY Implementation of the CKD-EPI 2021 eGFR equations represents progress toward health equity in the management of KD. Ongoing efforts by multidisciplinary teams, including clinical laboratorians, should focus on improved disease detection in clinically and socially high-risk populations. Routine use of cystatin C is recommended to improve the accuracy of eGFR, particularly in patients whose blood creatinine concentrations are confounded by processes other than glomerular filtration. When managing gender-diverse individuals, eGFR should be calculated and reported with both male and female coefficients. Gender-diverse individuals can benefit from a more holistic management approach, particularly at important clinical decision points.
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Affiliation(s)
- Christina C Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Hospital, Lancaster, PA, United States
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mark A Marzinke
- Departments of Pathology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Collister
- Division of Nephrology, University of Alberta, Edmonton, AB, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | | | - Melanie P Hoenig
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Thomas Lorey
- Kaiser Permanante, The Permanante Medical Group Regional Laboratory, Berkeley, CA, United States
| | - Paul M Palevsky
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Kidney Medicine Program and Kidney Medicine Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, United States
- The National Kidney Foundation, Inc., New York, NY, United States
| | - Octavia Peck Palmer
- Departments of Pathology, Critical Care Medicine, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Sylvia E Rosas
- The National Kidney Foundation, Inc., New York, NY, United States
- Kidney and Hypertension Unit, Joslin Diabetes Center and Harvard Medical School, Boston, MA, United States
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Joseph Vassalotti
- The National Kidney Foundation, Inc., New York, NY, United States
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Cameron T Whitley
- Department of Sociology, Western Washington University, Bellingham, WA, United States
| | - Dina N Greene
- Department of Laboratory Medicine and Pathology, University of Washington Medicine, Seattle, WA, United States
- LetsGetChecked Laboratories, Monrovia, CA, United States
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Ahmed SB, Beach LB, Safer JD, Veale JF, Whitley CT. Considerations in the care of transgender persons. Nat Rev Nephrol 2023; 19:360-365. [PMID: 37069283 DOI: 10.1038/s41581-023-00713-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
- O'Brien Institute for Public Health, Calgary, Alberta, Canada.
- Alberta Kidney Disease Network, Calgary, Alberta, Canada.
| | - Lauren B Beach
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
- Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
- ADVOCATE SGM Health Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
| | - Joshua D Safer
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA.
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jaimie F Veale
- Te Kura Whatu Oho Mauri School of Psychology, University of Waikato, Hamilton, Aotearoa New Zealand.
| | - Cameron T Whitley
- Department of Sociology, Western Washington University, Bellingham, WA, USA.
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Park KJ, Cho SH. The transgender organ donor: New frontiers in advocacy for mental health providers. Journal of Gay & Lesbian Mental Health 2020. [DOI: 10.1080/19359705.2020.1798701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kelly J. Park
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California (USC)/Los Angeles County + USC Medical Center, Los Angeles, California, USA
| | - Stephanie H. Cho
- Department of Psychiatry and the Behavioral Sciences, Keck Medicine of the University of Southern California, Los Angeles, California, USA
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