1
|
Miano TA, Barreto EF, McNett M, Martin N, Sakhuja A, Andrews A, Basu RK, Ablordeppey EA. Toward Equitable Kidney Function Estimation in Critical Care Practice: Guidance From the Society of Critical Care Medicine's Diversity, Equity, and Inclusion in Renal Clinical Practice Task Force. Crit Care Med 2024; 52:951-962. [PMID: 38407240 PMCID: PMC11098700 DOI: 10.1097/ccm.0000000000006237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Accurate glomerular filtration rate (GFR) assessment is essential in critically ill patients. GFR is often estimated using creatinine-based equations, which require surrogates for muscle mass such as age and sex. Race has also been included in GFR equations, based on the assumption that Black individuals have genetically determined higher muscle mass. However, race-based GFR estimation has been questioned with the recognition that race is a poor surrogate for genetic ancestry, and racial health disparities are driven largely by socioeconomic factors. The American Society of Nephrology and the National Kidney Foundation (ASN/NKF) recommend widespread adoption of new "race-free" creatinine equations, and increased use of cystatin C as a race-agnostic GFR biomarker. DATA SOURCES Literature review and expert consensus. STUDY SELECTION English language publications evaluating GFR assessment and racial disparities. DATA EXTRACTION We provide an overview of the ASN/NKF recommendations. We then apply an Implementation science methodology to identify facilitators and barriers to implementation of the ASN/NKF recommendations into critical care settings and identify evidence-based implementation strategies. Last, we highlight research priorities for advancing GFR estimation in critically ill patients. DATA SYNTHESIS Implementation of the new creatinine-based GFR equation is facilitated by low cost and relative ease of incorporation into electronic health records. The key barrier to implementation is a lack of direct evidence in critically ill patients. Additional barriers to implementing cystatin C-based GFR estimation include higher cost and lack of test availability in most laboratories. Further, cystatin C concentrations are influenced by inflammation, which complicates interpretation. CONCLUSIONS The lack of direct evidence in critically ill patients is a key barrier to broad implementation of newly developed "race-free" GFR equations. Additional research evaluating GFR equations in critically ill patients and novel approaches to dynamic kidney function estimation is required to advance equitable GFR assessment in this vulnerable population.
Collapse
Affiliation(s)
- Todd A. Miano
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Erin F. Barreto
- Department of Pharmacy, Mayo Clinic, Rochester, MN, United States of America
| | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, Ohio
| | - Niels Martin
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ankit Sakhuja
- Division of Data Driven and Digital Medicine, The Charles Bronfman Institute for Personalized Medicine and Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adair Andrews
- Society of Critical Care Medicine, Mount Prospect, IL
| | - Rajit K. Basu
- Ann & Robert Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Enyo Ama Ablordeppey
- Washington University School of Medicine, Department of Anesthesiology and Emergency Medicine, St. Louis, Missouri
| |
Collapse
|
2
|
Agyemang C, van der Linden EL, Chilunga F, van den Born BJH. International Migration and Cardiovascular Health: Unraveling the Disease Burden Among Migrants to North America and Europe. J Am Heart Assoc 2024; 13:e030228. [PMID: 38686900 DOI: 10.1161/jaha.123.030228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/26/2023] [Indexed: 05/02/2024]
Abstract
Europe and North America are the 2 largest recipients of international migrants from low-resource regions in the world. Here, large differences in cardiovascular disease (CVD) morbidity and death exist between migrants and the host populations. This review discusses the CVD burden and its most important contributors among the largest migrant groups in Europe and North America as well as the consequences of migration to high-income countries on CVD diagnosis and therapy. The available evidence indicates that migrants in Europe and North America generally have a higher CVD risk compared with the host populations. Cardiometabolic, behavioral, and psychosocial factors are important contributors to their increased CVD risk. However, despite these common denominators, there are important ethnic differences in the propensity to develop CVD that relate to pre- and postmigration factors, such as socioeconomic status, cultural factors, lifestyle, psychosocial stress, access to health care and health care usage. Some of these pre- and postmigration environmental factors may interact with genetic (epigenetics) and microbial factors, which further influence their CVD risk. The limited number of prospective cohorts and clinical trials in migrant populations remains an important culprit for better understanding pathophysiological mechanism driving health differences and for developing ethnic-specific CVD risk prediction and care. Only by improved understanding of the complex interaction among human biology, migration-related factors, and sociocultural determinants of health influencing CVD risk will we be able to mitigate these differences and truly make inclusive personalized treatment possible.
Collapse
Affiliation(s)
- Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC University of Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Eva L van der Linden
- Department of Public and Occupational Health, Amsterdam UMC University of Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
- Department of Vascular Medicine, Amsterdam UMC University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Felix Chilunga
- Department of Public and Occupational Health, Amsterdam UMC University of Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
| | - Bert-Jan H van den Born
- Department of Public and Occupational Health, Amsterdam UMC University of Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
- Department of Vascular Medicine, Amsterdam UMC University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| |
Collapse
|
3
|
Siddique SM, Tipton K, Leas B, Jepson C, Aysola J, Cohen JB, Flores E, Harhay MO, Schmidt H, Weissman GE, Fricke J, Treadwell JR, Mull NK. The Impact of Health Care Algorithms on Racial and Ethnic Disparities : A Systematic Review. Ann Intern Med 2024; 177:484-496. [PMID: 38467001 DOI: 10.7326/m23-2960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND There is increasing concern for the potential impact of health care algorithms on racial and ethnic disparities. PURPOSE To examine the evidence on how health care algorithms and associated mitigation strategies affect racial and ethnic disparities. DATA SOURCES Several databases were searched for relevant studies published from 1 January 2011 to 30 September 2023. STUDY SELECTION Using predefined criteria and dual review, studies were screened and selected to determine: 1) the effect of algorithms on racial and ethnic disparities in health and health care outcomes and 2) the effect of strategies or approaches to mitigate racial and ethnic bias in the development, validation, dissemination, and implementation of algorithms. DATA EXTRACTION Outcomes of interest (that is, access to health care, quality of care, and health outcomes) were extracted with risk-of-bias assessment using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool and adapted CARE-CPM (Critical Appraisal for Racial and Ethnic Equity in Clinical Prediction Models) equity extension. DATA SYNTHESIS Sixty-three studies (51 modeling, 4 retrospective, 2 prospective, 5 prepost studies, and 1 randomized controlled trial) were included. Heterogenous evidence on algorithms was found to: a) reduce disparities (for example, the revised kidney allocation system), b) perpetuate or exacerbate disparities (for example, severity-of-illness scores applied to critical care resource allocation), and/or c) have no statistically significant effect on select outcomes (for example, the HEART Pathway [history, electrocardiogram, age, risk factors, and troponin]). To mitigate disparities, 7 strategies were identified: removing an input variable, replacing a variable, adding race, adding a non-race-based variable, changing the racial and ethnic composition of the population used in model development, creating separate thresholds for subpopulations, and modifying algorithmic analytic techniques. LIMITATION Results are mostly based on modeling studies and may be highly context-specific. CONCLUSION Algorithms can mitigate, perpetuate, and exacerbate racial and ethnic disparities, regardless of the explicit use of race and ethnicity, but evidence is heterogeneous. Intentionality and implementation of the algorithm can impact the effect on disparities, and there may be tradeoffs in outcomes. PRIMARY FUNDING SOURCE Agency for Healthcare Quality and Research.
Collapse
Affiliation(s)
- Shazia Mehmood Siddique
- Division of Gastroenterology, University of Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania; and Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (S.M.S.)
| | - Kelley Tipton
- ECRI-Penn Medicine Evidence-based Practice Center, ECRI, Plymouth Meeting, Pennsylvania (K.T., C.J., J.R.T.)
| | - Brian Leas
- Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (B.L., E.F., J.F.)
| | - Christopher Jepson
- ECRI-Penn Medicine Evidence-based Practice Center, ECRI, Plymouth Meeting, Pennsylvania (K.T., C.J., J.R.T.)
| | - Jaya Aysola
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Division of General Internal Medicine, University of Pennsylvania; and Penn Medicine Center for Health Equity Advancement, Penn Medicine, Philadelphia, Pennsylvania (J.A.)
| | - Jordana B Cohen
- Division of Renal-Electrolyte and Hypertension, University of Pennsylvania; and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania (J.B.C.)
| | - Emilia Flores
- Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (B.L., E.F., J.F.)
| | - Michael O Harhay
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Center for Evidence-Based Practice, Penn Medicine; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; and Division of Pulmonary and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania (M.O.H.)
| | - Harald Schmidt
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania (H.S.)
| | - Gary E Weissman
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; and Division of Pulmonary and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W.)
| | - Julie Fricke
- Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (B.L., E.F., J.F.)
| | - Jonathan R Treadwell
- ECRI-Penn Medicine Evidence-based Practice Center, ECRI, Plymouth Meeting, Pennsylvania (K.T., C.J., J.R.T.)
| | - Nikhil K Mull
- Center for Evidence-Based Practice, Penn Medicine; and Division of Hospital Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (N.K.M.)
| |
Collapse
|
4
|
Butrovich MA, Qin J, Xue X, Ivy SP, Nolin TD, Beumer JH. Impact of the 2021 CKD-EPI equation on anticancer pharmacotherapy in black and non-black cancer patients. Cancer Lett 2024; 586:216679. [PMID: 38307411 PMCID: PMC10939791 DOI: 10.1016/j.canlet.2024.216679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/14/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
Cancer and kidney disease disproportionately impact Black patients. The CKD-EPI2021 equation was developed to estimate glomerular filtration rate (eGFR) without using race. We assessed the impact of using CKD-EPI2021 instead of CKD-EPI2009 or Cockcroft-Gault (CG) on dosing and eligibility of anticancer drugs in Black and non-Black patients. Utilizing the National Cancer Institute Theradex database, deindexed eGFR (mL/min) was calculated for 3931 patients (8.6 % Black) using CKD-EPI2021, CKD-EPI2009, and CG. Dosing simulations based on each eGFR were performed for ten anticancer drugs with kidney function-based eligibility or dosing cutoffs. eGFR differences using CKD-EPI2021 versus CKD-EPI2009 varied between Black and non-Black patients (p < 0.001); on average, Black patients had 10.3 mL/min lower eGFR and non-Black patients had 4.2 mL/min higher eGFR using CKD-EPI2021. This corresponded to a difference in relative odds of cisplatin ineligibility using CKD-EPI2021 versus CKD-EPI2009; Black patients had 48 % higher odds of ineligibility and non-Black patients had 27 % lower odds of ineligibility using CKD-EPI2021 (p < 0.001). When using CKD-EPI2021 versus CG, eGFR differences were similar between Black and non-Black patients (p = 0.679) and relative difference in odds of cisplatin ineligibility did not vary. Using CKD-EPI2021 versus CKD-EPI2009 differentially impacts Black versus non-Black cancer patients; Black patients have lower calculated eGFR and are less likely to receive full doses of drug using CKD-EPI2021. From the historical default of CG, adopting CKD-EPI2021 would not disparately impact patients based on race, but would result in Black patients being less likely to receive full doses of drug than if CKD-EPI2009 were used.
Collapse
Affiliation(s)
- Morgan A Butrovich
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jiyue Qin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, 10461, USA; Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, 10461, USA
| | - S Percy Ivy
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Thomas D Nolin
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA; Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Jan H Beumer
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA; Hematology/Oncology Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| |
Collapse
|
5
|
Schmeusser BN, Nicaise EH, Palacios AR, Ali A, Patil DH, Armas-Phan M, Ogan K, Master VA. Performance of Future Glomerular Filtration Rate Equation by Race in a Large, Racially Diverse Patient Cohort Undergoing Nephrectomy for Renal Cell Carcinoma. Urology 2024; 183:147-156. [PMID: 37852308 DOI: 10.1016/j.urology.2023.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To examine the performance of the Palacios et al [Aguilar Palacios D, Wilson B, Ascha M, et al. New baseline renal function after radical or partial nephrectomy: a simple and accurate predictive model. J Urol. 2021;205:1310-1320] post-nephrectomy future glomerular function rate (fGFR) equation in a diverse cohort using both the Chronic Kidney Disease Epidemiology (CKD-EPI) 2009 equation with race, used in the creation of the formula, as well as the CKD-EPI 2021 equation without race. METHODS Patients who underwent partial or radical nephrectomy for renal cell carcinoma from 2005-2021 were identified in our institutional database. Patients with creatinine values preoperatively and 3-12 months postoperatively were included. Correlation/bias/accuracy/precision of the fGFR equation (fGFR = 35+ [preoperative eGFR × 0.65] - 18 [if radical] - [age × 0.25] + 3 [if tumor >7 cm] - 2 [if diabetes]) with observed postoperative eGFR was determined by both the CKD-EPI-2021 and CKD-EPI 2009 equations. RESULTS A total of 1443 patients were analyzed. Seventy-one percent (1024) were White and 22.9% (331) were Black. Most underwent radical nephrectomy (60.3%). 40% T3-T4 renal cell carcinoma (RCC), with 14.8% of patients having M1 disease. Median observed vs predicted fGFR was 58.0 vs 58.7 mL/min/1.73 m2 for CKD-EPI 2021 and 56.0 vs 57.5 for CKD-EPI 2009. For the total cohort, the correlation/bias/accuracy/precision of the fGFR equation was 0.805/-0.5/81.7/7.9-9.0 for CKD-EPI 2021 and 0.809/-0.8/81.3/-8.1 to 8 for CKD-EPI 2009. In Black patients, fGFR equation demonstrated >75% accuracy with both CKD-EPI equations; however, accuracy was lower in black patients with the CKD-EPI2021 equation (76.1% vs 83.4%, P = .003). CONCLUSION The fGFR equation performed well in our large, diverse cohort, though accuracy was relatively lower when using CKD-EPI 2021 compared to CKD-EPI 2009.
Collapse
Affiliation(s)
| | - Edouard H Nicaise
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Arnold R Palacios
- Department of Urology, Creighton University School of Medicine, Omaha, NE
| | - Adil Ali
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | - Manuel Armas-Phan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
| |
Collapse
|
6
|
Schmeusser BN, Nicaise EH, Ogan K, Master VA. AUTHOR REPLY. Urology 2024; 183:155-156. [PMID: 37985283 DOI: 10.1016/j.urology.2023.07.052] [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: 11/22/2023]
Affiliation(s)
| | - Edouard H Nicaise
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
| |
Collapse
|
7
|
Liu MC, Niu WQ, Wang YF, Meng Y, Zheng GM, Cai Z, Shen C, Zhu XG, Wang MD, Li JL, Zhao WJ, Wang YX. Coagulation Function and Type 2 Diabetic Kidney Disease: A Real-World Observational Study. J Diabetes Res 2023; 2023:8848096. [PMID: 38094871 PMCID: PMC10719035 DOI: 10.1155/2023/8848096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/15/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Objectives Type 2 diabetic kidney disease (DKD), a chronic microvascular complication of diabetes, may exhibit a complex interrelation with coagulation function. This study is aimed at elucidating the association between coagulation function and DKD. Methods This was a real-world observational study conducted in Beijing, involving 2,703 participants. All patients with diabetes were classified into two groups, viz., DKD and non-DKD groups. Effect magnitudes are denoted as odds ratios (OR) with a 95% confidence interval (CI). To mitigate potential bias in group comparisons, we employed propensity score matching (PSM). Results After adjusting for variables such as age, gender, systolic blood pressure (SBP), hemoglobin A1c (HbA1c), triglyceride (TG), c-reactive protein (CRP), platelet (PLT), and serum albumin (sALB), it was discerned that fibrinogen (FIB) (OR, 95% CI, P: 1.565, 1.289-1.901, <0.001) and fibrinogen degradation products (FDP) (1.203, 1.077-1.344, 0.001) were significantly correlated with an increased risk of DKD. To facilitate clinical applications, a nomogram prediction model was established, demonstrating commendable accuracy for DKD prediction. Conclusions Our findings suggest that elevated levels of FIB and FDP serve as potential risk indicators for DKD, and coagulation function may play an important role in the occurrence and development of DKD.
Collapse
Affiliation(s)
- Meng-chao Liu
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Wen-quan Niu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
| | - Yue-fen Wang
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yuan Meng
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Gui-min Zheng
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Zhen Cai
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Cun Shen
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Xiang-gang Zhu
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Meng-di Wang
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jia-lin Li
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Wen-jing Zhao
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yao-xian Wang
- Henan University of Chinese Medicine, China
- The First Clinical Medical College, Beijing University of Chinese Medicine, China
| |
Collapse
|
8
|
Munch PV, Heide-Jørgensen U, Jensen SK, Birn H, Vestergaard SV, Frøkiær J, Sørensen HT, Christiansen CF. Performance of the race-free CKD-EPI creatinine-based eGFR equation in a Danish cohort with measured GFR. Clin Kidney J 2023; 16:2728-2737. [PMID: 38046001 PMCID: PMC10689151 DOI: 10.1093/ckj/sfad253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Indexed: 12/05/2023] Open
Abstract
Background In 2021, an updated Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimated glomerular filtration rate (eGFR) without a coefficient for race (CKD-EPI21) was developed. The performance of this new equation has yet to be examined among specific patient groups. Methods We compared the performances of the new CKD-EPI21 equation and the 2009 equation assuming non-Black race (CKD-EPI09-NB) in patients with GFR measured by chromium-51-EDTA plasma clearance at Aarhus University Hospital in Denmark during 2010-18. We examined bias, accuracy, precision and correct classification of chronic kidney disease (CKD) stage using chromium-51-EDTA clearance as the reference standard. We assessed the performance in the total cohort, cancer patients and potential living kidney donors. We also assessed the performance stratified by CKD stage in the total cohort. Results In this predominantly white population, the CKD-EPI21 equation performed slightly better than the CKD-EPI09-NB equation in both the total cohort (N = 4668), and in cancer patients (N = 3313) and potential living kidney donors (N = 239). In the total cohort, the CKD-EPI21 equation demonstrated a slightly lower median absolute bias (-0.2 versus -4.4 mL/min/1.73 m2), and a similar accuracy, precision and correct classification of CKD stage compared with the CKD-EPI09-NB equation. When stratified by CKD stage, the CKD-EPI09-NB equation performed slightly better than the CKD-EPI21 equation among patients with a measured GFR (mGFR) <60 mL/min/1.73 m2. Conclusions In a selected cohort of Danish patients with mGFR, the CKD-EPI21 equation performed slightly better than the CKD-EPI09-NB equation except for patients with a mGFR <60 mL/min/1.73 m2, where CKD-EPI09-NB performed slightly better although the differences were considered clinically insignificant.
Collapse
Affiliation(s)
- Philip Vestergaard Munch
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Midtjylland, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Midtjylland, Denmark
| | - Simon Kok Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Midtjylland, Denmark
| | - Henrik Birn
- Department of Clinical Medicine, Aarhus University, Aarhus, Midtjylland, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Søren Viborg Vestergaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Midtjylland, Denmark
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Frøkiær
- Department of Clinical Medicine, Aarhus University, Aarhus, Midtjylland, Denmark
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Midtjylland, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Midtjylland, Denmark
| |
Collapse
|
9
|
Liu MC, Li JL, Wang YF, Meng Y, Zheng GM, Cai Z, Shen C, Wang MD, Zhu XG, Chen YZ, Wang YL, Zhao WJ, Niu WQ, Wang YX. Association between serum complements and kidney function in patients with diabetic kidney disease. Front Endocrinol (Lausanne) 2023; 14:1195966. [PMID: 38047115 PMCID: PMC10690951 DOI: 10.3389/fendo.2023.1195966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Objective We aimed to explore the association between serum complements and kidney function of diabetic kidney disease (DKD) in Chinese patients. Methods This is a retrospective study involving 2,441 participants. DKD was diagnosed according to the Kidney Disease: Improving Global Outcomes (KDIGO) categories. Participants were classified as stages G1-G5 by KDIGO glomerular filtration rate (GFR) categories. Effect sizes are expressed as odds ratio (OR) with 95% confidence interval (CI). Results After balancing age, gender, systolic blood pressure (SBP), hemoglobin A1c (HbA1C), serum triglyceride (TG), and urinary albumin-to-creatinine ratio (UACR) between the G2-G5 and control groups, per 0.1 g/L increment in serum complement C3 was significantly associated with a 27.8% reduced risk of DKD at G5 stage (OR, 95% CI, P: 0.722, 0.616-0.847, <0.001) relative to the G1 stage. Conversely, per 0.1 g/L increment in serum complement C4 was associated with an 83.0-177.6% increased risk of G2-G5 stage (P<0.001). Serum complement C1q was not statistically significant compared to controls at all stages prior to or after propensity score matching. Conclusions Our results indicate that high concentrations of serum C4 were associated with the significantly elevated risk of kidney function deterioration across all stages, and reduced serum C3 levels with an increased risk of DKD stage G5.
Collapse
Affiliation(s)
- Meng-chao Liu
- The First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jia-lin Li
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yue-fen Wang
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yuan Meng
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Gui-min Zheng
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Zhen Cai
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Cun Shen
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Meng-di Wang
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Xiang-gang Zhu
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yang-zi Chen
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yu-lin Wang
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Wen-jing Zhao
- Department of Nephropathy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Wen-quan Niu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
| | - Yao-xian Wang
- The First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
- Henan University of Chinese Medicine, Zhengzhou, China
| |
Collapse
|
10
|
Avilez ND, Nolazco JI, Chang SL, Reis LO. Urological impact of race-free estimated glomerular filtration rate equations. Int Braz J Urol 2023; 49:665-667. [PMID: 37903003 PMCID: PMC10947618 DOI: 10.1590/s1677-5538.ibju.2023.9913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/10/2023] [Indexed: 11/01/2023] Open
Affiliation(s)
- Natália Dalsenter Avilez
- Universidade Estadual de CampinasCampinasSPBrasilUroScience, Universidade Estadual de Campinas (Unicamp). Campinas, SP, Brasil;
| | - José Ignacio Nolazco
- Harvard Medical SchoolBrigham and Women's HospitalDivision of Urological SurgeryBostonMAUSADivision of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School. Boston, MA, USA;
- Universidad AustralHospital Universitario AustralProvincia de Buenos AiresArgentinaServicio de Urología, Hospital Universitario Austral, Universidad Austral. Provincia de Buenos Aires, Argentina;
| | - Steven Lee Chang
- Harvard Medical SchoolBrigham and Women's HospitalDivision of Urological SurgeryBostonMAUSADivision of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School. Boston, MA, USA;
- Dana-Farber Cancer InstituteLank Center for Genitourinary OncologyBostonMAUSALank Center for Genitourinary Oncology, Dana-Farber Cancer Institute. Boston, MA, USA;
| | - Leonardo O. Reis
- Universidade Estadual de CampinasCampinasSPBrasilUroScience, Universidade Estadual de Campinas (Unicamp). Campinas, SP, Brasil;
- Pontifícia Universidade Católica de CampinasFaculdade de Ciências da VidaDepartamento de Oncologia UrológicaCampinasSPBrasilDepartamento de Oncologia Urológica, Faculdade de Ciências da Vida, Pontifícia Universidade Católica de Campinas (PUC-Campinas). Campinas, SP, Brasil
| |
Collapse
|
11
|
Uzendu A, Kennedy K, Chertow G, Amin AP, Giri JS, Rymer JA, Bangalore S, Lavin K, Anderson C, Spertus JA. Implications of a Race Term in GFR Estimates Used to Predict AKI After Coronary Intervention. JACC Cardiovasc Interv 2023; 16:2309-2320. [PMID: 37758386 DOI: 10.1016/j.jcin.2023.07.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/06/2023] [Accepted: 07/25/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The prediction of mortality, bleeding, and acute kidney injury (AKI) after percutaneous coronary intervention (PCI) traditionally relied on race-based estimates of the glomerular filtration rate (GFR). Recently, race agnostic equations were developed to advance equity. OBJECTIVES The authors aimed to compare the accuracy and implications of various GFR equations when used to predict AKI after PCI. METHODS Using the National Cardiovascular Data Registry (NCDR) CathPCI data set, we identified patients undergoing PCI in 2020 and calculated their AKI risk using the 2014 NCDR AKI risk model. We created 4 AKI models per patient for each estimate of baseline renal function: the traditional GFR equation with a race term, 2 GFR equations without a race term, and serum creatinine alone. We then compared each model's performance predicting AKI. RESULTS Among 455,806 PCI encounters, the median age was 67 years, 32.2% were women, and 8.5% were Black. In Black patients, risk models without a race term were better calibrated than models incorporating an equation with a race term (intercept: -0.01 vs 0.15). Race-agnostic models reclassified 6% of Black patients into higher-risk categories, potentially prompting appropriate mitigation efforts. However, even with a race-agnostic model, AKI occurred in Black patients 18% more often than expected, which was not explained by captured patient or procedural characteristics. CONCLUSIONS Incorporating a GFR estimate without a Black race term into the NCDR AKI risk prediction model yielded more accurate prediction of AKI risk for Black patients, which has important implications for reducing disparities and benchmarking.
Collapse
Affiliation(s)
- Anezi Uzendu
- Cardiovascular Outcomes, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri Kansas City, Kansas City, Missouri, USA.
| | - Kevin Kennedy
- Cardiovascular Outcomes, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Glenn Chertow
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Amit P Amin
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Jay S Giri
- Penn Center for Quality, Outcomes, and Evaluative Research, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer A Rymer
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Sripal Bangalore
- Department of Medicine, New York University Langone, New York, New York, USA
| | - Kimberly Lavin
- Department of Science and Quality, American College of Cardiology, Washington, DC, USA
| | - Cornelia Anderson
- Department of Science and Quality, American College of Cardiology, Washington, DC, USA
| | - John A Spertus
- Cardiovascular Outcomes, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri Kansas City, Kansas City, Missouri, USA
| |
Collapse
|
12
|
Williams P. Retaining Race in Chronic Kidney Disease Diagnosis and Treatment. Cureus 2023; 15:e45054. [PMID: 37701164 PMCID: PMC10495104 DOI: 10.7759/cureus.45054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/14/2023] Open
Abstract
The best overall measure of kidney function is glomerular filtration rate (GFR) as commonly estimated from serum creatinine concentrations (eGFRcr) using formulas that correct for the higher average creatinine concentrations in Blacks. After two decades of use, these formulas have come under scrutiny for estimating GFR differently in Blacks and non-Blacks. Discussions of whether to include race (Black vs. non-Black) in the calculation of eGFRcr fail to acknowledge that the original race-based eGFRcr provided the same CKD treatment recommendations for Blacks and non-Blacks based on directly (exogenously) measured GFR. Nevertheless, the National Kidney Foundation and the American Society of Nephrology Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease removed race in CKD treatment guidelines and pushed for the immediate adoption of a race-free eGFRcr formula by physicians and clinical laboratories. This formula is projected to negate CKD in 5.51 million White and other non-Black adults and reclassify CKD to less severe stages in another 4.59 million non-Blacks, in order to expand treatment eligibility to 434,000 Blacks not previously diagnosed and to 584,000 Blacks previously diagnosed with less severe CKD. This review examines: 1) the validity of the arguments for removing the original race correction, and 2) the performance of the proposed replacement formula. Excluding race in the derivation of eGFRcr changed the statistical bias from +3.7 to -3.6 ml/min/1.73m2 in Blacks and from +0.5 to +3.9 in non-Blacks, i.e., promoting CKD diagnosis in Blacks at the cost of restricting diagnosis in non-Blacks. By doing so, the revised eGFRcr greatly exaggerates the purported racial disparity in CKD burden. Claims that the revised formulas identify heretofore undiagnosed CKD in Blacks are not supported when studies that used kidney failure replacement therapy and mortality are interpreted as proxies for baseline CKD. Alternatively, a race-stratified eGFRcr (i.e., separate equations for Blacks and non-Blacks) would provide the least biased eGFRcr for both Blacks and non-Blacks and the best medical treatment for all patients.
Collapse
Affiliation(s)
- Paul Williams
- Life Sciences, Lawrence Berkeley National Laboratory, Berkeley, USA
| |
Collapse
|
13
|
Raynaud M, Al-Awadhi S, Juric I, Divard G, Lombardi Y, Basic-Jukic N, Aubert O, Dubourg L, Masson I, Mariat C, Prié D, Pernin V, Le Quintrec M, Larson TS, Stegall MD, Bikbov B, Ruggenenti P, Mesnard L, Ibrahim HN, Nielsen MB, Matas AJ, Nankivell BJ, Benjamens S, Pol RA, Bakker SJL, Jouven X, Legendre C, Kamar N, Smith BH, Wadei HM, Durrbach A, Vincenti F, Remuzzi G, Lefaucheur C, Bentall AJ, Loupy A. Race-free estimated glomerular filtration rate equation in kidney transplant recipients: development and validation study. BMJ 2023; 381:e073654. [PMID: 37257905 PMCID: PMC10231444 DOI: 10.1136/bmj-2022-073654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To compare the performance of a newly developed race-free kidney recipient specific glomerular filtration rate (GFR) equation with the three current main equations for measuring GFR in kidney transplant recipients. DESIGN Development and validation study SETTING: 17 cohorts in Europe, the United States, and Australia (14 transplant centres, three clinical trials). PARTICIPANTS 15 489 adults (3622 in development cohort (Necker, Saint Louis, and Toulouse hospitals, France), 11 867 in multiple external validation cohorts) who received kidney transplants between 1 January 2000 and 1 January 2021. MAIN OUTCOME MEASURE The main outcome measure was GFR, measured according to local practice. Performance of the GFR equations was assessed using P30 (proportion of estimated GFR (eGFR) within 30% of measured GFR (mGFR)) and correct classification (agreement between eGFR and mGFR according to GFR stages). The race-free equation, based on creatinine level, age, and sex, was developed using additive and multiplicative linear regressions, and its performance was compared with the three current main GFR equations: Modification of Diet in Renal Disease (MDRD) equation, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 equation, and race-free CKD-EPI 2021 equation. RESULTS The study included 15 489 participants, with 50 464 mGFR and eGFR values. The mean GFR was 53.18 mL/min/1.73m2 (SD 17.23) in the development cohort and 55.90 mL/min/1.73m2 (19.69) in the external validation cohorts. Among the current GFR equations, the race-free CKD-EPI 2021 equation showed the lowest performance compared with the MDRD and CKD-EPI 2009 equations. When race was included in the kidney recipient specific GFR equation, performance did not increase. The race-free kidney recipient specific GFR equation showed significantly improved performance compared with the race-free CKD-EPI 2021 equation and performed well in the external validation cohorts (P30 ranging from 73.0% to 91.3%). The race-free kidney recipient specific GFR equation performed well in several subpopulations of kidney transplant recipients stratified by race (P30 73.0-91.3%), sex (72.7-91.4%), age (70.3-92.0%), body mass index (64.5-100%), donor type (58.5-92.9%), donor age (68.3-94.3%), treatment (78.5-85.2%), creatinine level (72.8-91.3%), GFR measurement method (73.0-91.3%), and timing of GFR measurement post-transplant (72.9-95.5%). An online application was developed that estimates GFR based on recipient's creatinine level, age, and sex (https://transplant-prediction-system.shinyapps.io/eGFR_equation_KTX/). CONCLUSION A new race-free kidney recipient specific GFR equation was developed and validated using multiple, large, international cohorts of kidney transplant recipients. The equation showed high accuracy and outperformed the race-free CKD-EPI 2021 equation that was developed in individuals with native kidneys. TRIAL REGISTRATION ClinicalTrials.gov NCT05229939.
Collapse
Affiliation(s)
- Marc Raynaud
- Université de Paris Cité, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, F-75015 Paris, France
| | - Solaf Al-Awadhi
- Université de Paris Cité, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, F-75015 Paris, France
| | - Ivana Juric
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Gillian Divard
- Université de Paris Cité, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, F-75015 Paris, France
| | - Yannis Lombardi
- Department of Nephrology and Acute Kidney Intensive Care, Tenon Hospital, Paris, France
| | - Nikolina Basic-Jukic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Olivier Aubert
- Université de Paris Cité, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, F-75015 Paris, France
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
| | - Laurence Dubourg
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France
| | - Ingrid Masson
- Department of Nephrology, Dialysis and Renal Transplantation, Nord Hospital, Jean Monnet University, Saint-Etienne, France
| | - Christophe Mariat
- Department of Nephrology, Dialysis and Renal Transplantation, Nord Hospital, Jean Monnet University, Saint-Etienne, France
| | - Dominique Prié
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
| | - Vincent Pernin
- Department of Nephrology, University Hospital Centre, Montpellier, France
| | - Moglie Le Quintrec
- Department of Nephrology, University Hospital Centre, Montpellier, France
| | - Timothy S Larson
- William J von Liebig Centre for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark D Stegall
- William J von Liebig Centre for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Boris Bikbov
- Department of Health Policy, Instituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Piero Ruggenenti
- Department of Renal Medicine, Clinical Research Centre for Rare Diseases "Aldo e Cele Daccò": Instituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
- Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Laurent Mesnard
- Department of Nephrology and Acute Kidney Intensive Care, Tenon Hospital, Paris, France
| | - Hassan N Ibrahim
- University of Texas Health Sciences Centre at Houston, Texas, USA
| | | | - Arthur J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Stan Benjamens
- Department of Surgery, University of Groningen and University Medical Centre Groningen, Groningen, Netherlands
| | - Robert A Pol
- Department of Surgery, University of Groningen and University Medical Centre Groningen, Groningen, Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen and University Medical Centre Groningen, Groningen, Netherlands
| | - Xavier Jouven
- Université de Paris Cité, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, F-75015 Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Paul Sabatier University, INSERM, Toulouse, France
| | - Byron H Smith
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | - Hani M Wadei
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | - Antoine Durrbach
- Department of Nephrology and Renal Transplantation, Henri-Mondor Hospital, Paris-Saclay University, Creteil, France
| | - Flavio Vincenti
- Department of Surgery, Kidney Transplant Service, University of California San Francisco, San Francisco, California, USA
| | - Giuseppe Remuzzi
- Department of Renal Medicine, Clinical Research Centre for Rare Diseases "Aldo e Cele Daccò": Instituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Carmen Lefaucheur
- Department of Kidney Transplantation, Saint Louis University Hospital, Paris, France
| | - Andrew J Bentall
- William J von Liebig Centre for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexandre Loupy
- Université de Paris Cité, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, F-75015 Paris, France
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
| |
Collapse
|
14
|
Abstract
Many chemotherapeutic drugs used to treat malignancies undergo renal clearance. Thus, accurate knowledge of kidney function is critical to ensure proper dosing, maximize efficacy, and minimize toxicity of drugs that often have a narrow therapeutic index. Making this issue more salient is the fact that impaired kidney function, as assessed by glomerular filtration rate (GFR), is encountered commonly in patients with cancer. Recent data and expert guidelines recommend the use of the Chronic Kidney Disease-Epidemiology Collaboration equation to guide the assessment of kidney function, except when directly measured GFR is clinically necessary. Controversies regarding the measurement of kidney function include the use of race in this equation, indexing to body surface area, and dosing of medications based on stages of chronic kidney disease versus more discrete values of estimated GFR. The development of accurate, real-time GFR measures may hold great promise in allowing for more accurate dosing of these important drugs.
Collapse
Affiliation(s)
- Mitchell H Rosner
- Division of Nephrology, University of Virginia Health, Charlottesville, VA.
| | - Ben Sprangers
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute for Medical Research, KU Leuven, Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Geeta Sandhu
- eviQ, Cancer Institute New South Wales, St Leonards, New South Wales, Australia
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| |
Collapse
|
15
|
Hughes JH, Woo KH, Keizer RJ, Goswami S. Clinical Decision Support for Precision Dosing: Opportunities for Enhanced Equity and Inclusion in Health Care. Clin Pharmacol Ther 2023; 113:565-574. [PMID: 36408716 DOI: 10.1002/cpt.2799] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022]
Abstract
Precision dosing aims to tailor doses to individual patients with the goal of improving treatment efficacy and avoiding toxicity. Clinical decision support software (CDSS) plays a crucial role in mediating this process, translating knowledge derived from clinical trials and real-world data (RWD) into actionable insights for clinicians to use at the point of care. However, not all patient populations are proportionally represented in clinical trials and other data sources that inform CDSS tools, limiting the applicability of these tools for underrepresented populations. Here, we review some of the limitations of existing CDSS tools and discuss methods for overcoming these gaps. We discuss considerations for study design and modeling to create more inclusive CDSS, particularly with an eye toward better incorporation of biological indicators in place of race, ethnicity, or sex. We also review inclusive practices for collection of these demographic data, during both study design and in software user interface design. Because of the role CDSS plays in both recording routine clinical care data and disseminating knowledge derived from data, CDSS presents a promising opportunity to continuously improve precision dosing algorithms using RWD to better reflect the diversity of patient populations.
Collapse
Affiliation(s)
| | - Kara H Woo
- InsightRX, San Francisco, California, USA
| | | | | |
Collapse
|
16
|
Li J, Liu S, Bian W, Yuan Z, Wang J, Niu J. Intravoxel incoherent motion diffusion-weighted MRI of renal parenchyma and its clinical significance in patients with untreated acute leukemia: a pilot study. Abdom Radiol (NY) 2023. [PMID: 36763120 DOI: 10.1007/s00261-023-03829-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE To evaluate quantitative parameters derived from intravoxel incoherent motion diffusion-weighted MRI (IVIM) of renal parenchyma in patients with untreated acute leukemia (AL) and analyze its prognostic significance and probable pathological mechanism. METHODS From March 2019 to November 2021, 67 newly diagnosed AL patients and 67 healthy controls matched in age and sex were recruited. All participants underwent IVIM in the kidneys, and D, D*, f, standard ADC values were measured. The differences of all parameters between AL and controls were analyzed. The relationship between imaging parameters and estimated glomerular filtration rate (eGFR) was studied. Univariable and multivariable analyses were performed to investigate prognostic significance of possible indicators. RESULTS The f and D value of renal medulla and D value of renal cortex in AL patients were lower than those in the healthy control group (t = - 2.173, t = - 3.463, t = - 2.030, respectively, all P < 0.05). The cortical f, cortical standard ADC, medullary f, and medullary standard ADC were correlated with the eGFR (r = 0.524, r = 0.401, r = 0.415, r = 0.325, respectively, all P < 0.05) in patients with AL. A medullary f value ≤ 9.51% (hazard ratio: 0.282; 95% confidence interval: 0.110, 0.719; P = 0.008) was associated with overall survival in a multivariable analysis. CONCLUSION The f and standard ADC values in renal parenchyma were the probable imaging markers of renal function in patients with newly diagnosed de novo AL. Lower renal medullary f value was a potential independent predictor for overall survival.
Collapse
|
17
|
Zingano CP, Escott GM, Rocha BM, Porgere IF, Moro CC, Delanaye P, Silveiro SP. 2009 CKD-EPI glomerular filtration rate estimation in Black individuals outside the United States: a systematic review and meta-analysis. Clin Kidney J 2023; 16:322-330. [PMID: 38021375 PMCID: PMC10665997 DOI: 10.1093/ckj/sfac238] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Indexed: 12/01/2023] Open
Abstract
Background The 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is the most used equation to estimate glomerular filtration rate (GFR), with race being a factor thereof, increasing GFR by 16% in self-identified Black persons compared with non-Black persons. However, recent publications indicate that it might overestimate GFR for Black adults outside the USA. In this meta-analysis, we assessed the accuracy, evaluated by the percentage of estimated GFR within 30% of measured GFR (P30), of the 2009 CKD-EPI equation in estimating GFR with and without the race coefficient in Black individuals outside the United States of America (USA). Methods We searched MEDLINE and Embase from inception to 9 July 2022, with no language restriction, supplemented by manual reference searches. Studies that assessed the CKD-EPI P30 accuracy with or without the race coefficient in Black adults outside the USA with an adequate method of GFR measurement were included. Data were extracted by independent pairs of reviewers and were pooled using a random-effects model. Results We included 11 studies, with a total of 1834 Black adults from South America, Africa and Europe. The race coefficient in the 2009 CKD-EPI equation significantly decreased P30 accuracy {61.9% [95% confidence interval (CI) 53-70%] versus 72.9% [95% CI 66.7-78.3%]; P = .03}. Conclusions Outside the USA, the 2009 CKD-EPI equation should not be used with the race coefficient, even though the 2009 CKD-EPI equation is not sufficiently accurate either way (<75%). Thus we endorse the Kidney Disease: Improving Global Outcomes guidelines to use exogenous filtration markers when this may impact clinical conduct.
Collapse
Affiliation(s)
- Carolina Pires Zingano
- Graduate Program in Medical Sciences: Endocrinology, Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto, Alegre
| | - Gustavo Monteiro Escott
- Graduate Program in Medical Sciences: Endocrinology, Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto, Alegre
| | - Bruna Martins Rocha
- Graduate Program in Medical Sciences: Endocrinology, Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto, Alegre
| | - Indianara Franciele Porgere
- Graduate Program in Medical Sciences: Endocrinology, Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto, Alegre
| | - Candice Cristine Moro
- Graduate Program in Medical Sciences: Endocrinology, Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto, Alegre
| | - Pierre Delanaye
- Department of Nephrology, Dialysis, Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Sandra Pinho Silveiro
- Graduate Program in Medical Sciences: Endocrinology, Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto, Alegre
- Division of Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
18
|
Pai MP, Sitaruno S, Abdelnabi M. Removing race and body surface area indexation for estimated kidney function based drug dosing: Aminoglycosides as justification of these principles. Pharmacotherapy 2023; 43:35-42. [PMID: 36401789 PMCID: PMC10098929 DOI: 10.1002/phar.2746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE The use of race in medicine can contribute to health inequity. Updated equations for estimated glomerular filtration rate (eGFR) without race have been published. Likewise, de-indexation of eGFR to body surface area (BSA) has been recommended by regulatory guidance for drug dosing in renal impairment. Clinical data justifying these recommendations for drug dosing are sparse. We examined the gain or loss of precision in drug dosing with estimated creatinine clearance (eCLcr) and eGFR using serum creatinine (eGFRcr) with and without race and BSA indexation by evaluating the population pharmacokinetics of the aminoglycosides as a classic drug class to probe kidney function. DESIGN Medical records from adult patients treated with gentamicin or tobramycin over a 13-year period were queried. Population pharmacokinetic analyses were performed using a 1-compartment base structural model. Models compared body size descriptors as covariates of the volume of distribution (V). Estimated creatinine clearance and eGFRcr using multiple contemporary equations with and without BSA indexation were tested as covariates of clearance (CL). MAIN RESULTS The final data set included 2968 patients treated with either gentamicin (20.2%) or tobramycin (79.8%). Patients self-identified as Caucasian (82%), African-American (10%), or other. The median [5th, 95th percentile] weight and BSA were 80.5 [49.4, 136] kg and 1.94 [1.48, 2.56] m2 , respectively. Models of eCLcr and eGFRcr without indexation to BSA had a better model fit than eGFRcr indexed to BSA for aminoglycoside CL. The 2021 Chronic Kidney Disease Epidemiology collaboration (CKD-EPI) eGFRcr equation (no race, no BSA indexation) provided a comparable model fit to the 2009 CKD-EPI eGFRcr equation (with race, no BSA indexation) for aminoglycoside CL. CONCLUSIONS Race is not a relevant covariate of aminoglycoside CL. The 2021 CKD-EPI eGFR equation without race and BSA indexation is a better method for gentamicin and tobramycin CL estimation. Confirmation of these results for other drugs can support the harmonization of dosing by kidney function.
Collapse
Affiliation(s)
- Manjunath P Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Sirima Sitaruno
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand
| | - Mohamed Abdelnabi
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW To review new publications about the use of the race coefficient in glomerular filtration rate (GFR)-estimating equations since this topic was last reviewed a year ago in Current Opinion in Nephrology and Hypertension . RECENT FINDINGS Accounting for race (or genetic ancestry) does improve the performance of GFR-estimating equations when serum creatinine (SCr) is used as the filtration marker but not when cystatin C is used. The National Kidney Foundation (NKF)-American Society of Nephrology (ASN) Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease recommended immediate adoption of a new refitted SCr-based equation without race and increased use of cystatin C. This report has created consensus but the endorsed new SCr equation without race underestimates GFR in Black Americans and overestimates GFR in non-Black Americans, which may result in diminished ability to detect racial disparities. SUMMARY The approach recommended by the NKF-ASN Task Force represents a compromise attempting to balance a number of competing values, including racial justice, benefit of classifying more Black Americans as having (more severe) chronic kidney disease, accuracy compared with measured GFR, and financial cost. The full implications of adopting the race-free refitted CKD-EPI SCr equation are yet to be known.
Collapse
Affiliation(s)
- Chi-yuan Hsu
- Division of Nephrology, University of California, San Francisco, San Francisco, CA, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| |
Collapse
|
20
|
Shafi T, Zhu X, Lirette ST, Rule AD, Mosley T, Butler KR, Hall ME, Vaitla P, Wynn JJ, Tio MC, Dossabhoy NR, Guallar E, Butler J. Quantifying Individual-Level Inaccuracy in Glomerular Filtration Rate Estimation : A Cross-Sectional Study. Ann Intern Med 2022; 175:1073-1082. [PMID: 35785532 DOI: 10.7326/m22-0610] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although the population-level differences between estimated glomerular filtration rate (eGFR) and measured glomerular filtration rate (mGFR) are well recognized, the magnitude and potential clinical implications of individual-level differences are unknown. OBJECTIVE To quantify the magnitude and consequences of the individual-level differences between mGFRs and eGFRs. DESIGN Cross-sectional study. SETTING Four U.S. community-based epidemiologic cohort studies with mGFR. PATIENTS 3223 participants in 4 studies. MEASUREMENTS The GFRs were measured using urinary iothalamate and plasma iohexol clearance; the eGFR was calculated from serum creatinine concentration alone (eGFRCR) and with cystatin C. All GFR results are presented as mL/min/1.73 m2. RESULTS The participants' mean age was 59 years; 32% were Black, 55% were women, and the mean mGFR was 68. The population-level differences between mGFR and eGFRCR were small; the median difference (mGFR - eGFR) was -0.6 (95% CI, -1.2 to -0.2); however, the individual-level differences were large. At an eGFRCR of 60, 50% of mGFRs ranged from 52 to 67, 80% from 45 to 76, and 95% from 36 to 87. At an eGFRCR of 30, 50% of mGFRs ranged from 27 to 38, 80% from 23 to 44, and 95% from 17 to 54. Substantial disagreement in chronic kidney disease staging by mGFR and eGFRCR was present. Among those with eGFRCR of 45 to 59, 36% had mGFR greater than 60 whereas 20% had mGFR less than 45; among those with eGFRCR of 15 to 29, 30% had mGFR greater than 30 and 5% had mGFR less than 15. The eGFR based on cystatin C did not provide substantial improvement. LIMITATION Single measurement of mGFR and serum markers without short-term replicates. CONCLUSION A substantial individual-level discrepancy exists between the mGFR and the eGFR. Laboratories reporting eGFR should consider including the extent of this uncertainty to avoid misinterpretation of eGFR as an mGFR replacement. PRIMARY FUNDING SOURCE National Institutes of Health.
Collapse
Affiliation(s)
- Tariq Shafi
- Division of Nephrology, Department of Medicine, Department of Physiology, and Department of Population Health, Bower School of Population Health, The University of Mississippi Medical Center, Jackson, Mississippi (T.S.)
| | - Xiaoqian Zhu
- Department of Data Science, Bower School of Population Health, The University of Mississippi Medical Center, Jackson, Mississippi (X.Z., S.T.L.)
| | - Seth T Lirette
- Department of Data Science, Bower School of Population Health, The University of Mississippi Medical Center, Jackson, Mississippi (X.Z., S.T.L.)
| | - Andrew D Rule
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minnesota (A.D.R.)
| | - Thomas Mosley
- The Mind Center, The University of Mississippi Medical Center, Jackson, Mississippi (T.M., K.R.B.)
| | - Kenneth R Butler
- The Mind Center, The University of Mississippi Medical Center, Jackson, Mississippi (T.M., K.R.B.)
| | - Michael E Hall
- Division of Cardiology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi (M.E.H.)
| | - Pradeep Vaitla
- Division of Nephrology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi (P.V., M.C.T.)
| | - James J Wynn
- Department of Surgery, The University of Mississippi Medical Center, Jackson, Mississippi (J.J.W.)
| | - Maria Clarissa Tio
- Division of Nephrology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi (P.V., M.C.T.)
| | - Neville R Dossabhoy
- Division of Nephrology, Department of Medicine, and Department of Physiology, The University of Mississippi Medical Center, Jackson, Mississippi (N.R.D.)
| | - Eliseo Guallar
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (E.G.)
| | - Javed Butler
- Division of Cardiology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi, and Baylor Scott & White Research Institute, Dallas, Texas (J.B.)
| |
Collapse
|
21
|
Akgül S, Chan BA, Manders PM. Carboplatin dose calculations for patients with lung cancer: significant dose differences found depending on dosing equation choice. BMC Cancer 2022; 22:829. [PMID: 35906566 PMCID: PMC9338596 DOI: 10.1186/s12885-022-09885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Carboplatin is the backbone cytotoxic agent for many chemotherapy regimens for lung cancer. Dosing of carboplatin is complicated due to its relationship to renal function and narrow therapeutic index. Overestimation of renal function may lead to supratherapeutic dosing and toxicity, while underestimation may lead to underdosing and therapeutic failure. Although the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations have higher accuracy in estimating glomerular filtration rate (eGFR), the Cockcroft Gault (CG) formula has been historically used for carboplatin dosing internationally. Methods We compared these formulae to identify patient profiles that were associated with significant carboplatin dose variation by retrospectively analysing the carboplatin dosing of 96 patients with lung cancer. Carboplatin doses were calculated using eGFR generated by MDRD, CKD-EPI 2009 and CKD-EPI 2021 equations. These three hypothetical doses were compared to actual CG-based doses prescribed. Results MDRD and CKD-EPI equations resulted in comparable carboplatin doses; however, CG doses diverged markedly with up to 17% of the patients receiving a carboplatin dose that was at least 20% higher than a non-CG formula would have predicted, and 20% received a dose that was at least 20% lower than a non-CG formula would have predicted. Our data suggest CG use overestimates kidney function in patients with a higher bodyweight and body surface area (BSA) while underestimating it in patients with a lower bodyweight and BSA. Importantly, we demonstrate potential real-world benefit as CKD-EPI predicted lower doses for patients whose (CG-derived) carboplatin dose was later reduced following clinical assessment prior to infusion. Conclusions We have therefore confirmed significant differences in carboplatin dosing depending on the equation used in our modern patient population and suggest that use of CKD-EPI provides the most clinically appropriate carboplatin dosing and should be implemented as the new standard of care internationally. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09885-7.
Collapse
Affiliation(s)
- Seçkin Akgül
- School of Medicine and Dentistry, Griffith University, Gold Coast, 4215 QLD, Australia
| | - Bryan A Chan
- School of Medicine and Dentistry, Griffith University, Gold Coast, 4215 QLD, Australia.,Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Birtinya, 4575 QLD, Australia
| | - Peter M Manders
- School of Medicine and Dentistry, Griffith University, Gold Coast, 4215 QLD, Australia. .,Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Birtinya, 4575 QLD, Australia.
| |
Collapse
|
22
|
Hara JH, Jutzy JM, Arya R, Kothari R, Mccall AR, Howard AR, Hasan Y, Cursio JF, Son CH. Predictors of acute hematologic toxicity in women receiving extended-field chemoradiation for cervical cancer: Do known pelvic radiation bone marrow constraints apply? Adv Radiat Oncol 2022. [DOI: 10.1016/j.adro.2022.100998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/05/2022] [Indexed: 11/18/2022] Open
|
23
|
Gray J, Hillman LA, Vivian E, St. Peter WL. Pharmacist's Role in Reducing
Medication‐Related
Racial Disparities in African American Patients with Chronic Kidney Disease. J Am Coll Clin Pharm 2022. [DOI: 10.1002/jac5.1653] [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: 11/12/2022]
Affiliation(s)
- Julie Gray
- University of Minnesota College of Pharmacy Minneapolis Minnesota
| | - Lisa A. Hillman
- University of Minnesota College of Pharmacy Minneapolis Minnesota
| | - Eva Vivian
- University of Wisconsin‐Madison School of Pharmacy Madison Wisconsin
| | | |
Collapse
|
24
|
Aklilu A, Delgado C. The removal of race from kidney function estimation: Key points for primary providers. J Natl Med Assoc 2022; 114:S25-S33. [PMID: 35595580 DOI: 10.1016/j.jnma.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Recent recognitions of longstanding societal effects of structural and overt acts of racism have led to calls for the elimination of race, a social construct, from medical algorithms. This accelerated a growing concern with the use of race in kidney function estimating equations. A task force sponsored by the two leading nephrology societies in the United States has reassessed the inclusion of race in glomerular filtration rate (GFR) estimation and recently put forth recommendations. New race-free equations have been developed and guides for widespread implementation have been provided. We herein review the journey of kidney function estimating equations, race in GFR estimating equations, new race-free equations and the path forward in caring for chronic kidney disease. We urge upon all primary care providers to employ concerted focus on early detection and identification of kidney dysfunction as well as risk factors including social determinants of health to prevent progression.
Collapse
Affiliation(s)
- Abinet Aklilu
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut; Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
| | - Cynthia Delgado
- Nephrology Section, San Francisco VA Medical Center and Division of Nephrology, University of California, San Francisco, California
| |
Collapse
|
25
|
Ghuman JK, Shi J, Zelnick LR, Hoofnagle AN, Mehrotra R, Bansal N. Impact of Removing Race Variable on CKD Classification Using the Creatinine-Based 2021 CKD-EPI Equation. Kidney Med 2022; 4:100471. [PMID: 35756325 PMCID: PMC9214432 DOI: 10.1016/j.xkme.2022.100471] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
26
|
Clark-Cutaia MN, Goldfarb DS. Editorial: New perspectives on estimated glomerular filtration rate and health equity. Curr Opin Nephrol Hypertens 2022; 31:157-9. [PMID: 35086985 DOI: 10.1097/MNH.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
27
|
Affiliation(s)
- Akinlolu Ojo
- University of Kansas Medical Center, Kansas City, Kansas
| |
Collapse
|
28
|
Delgado C, Baweja M, Crews DC, Eneanya ND, Gadegbeku CA, Inker LA, Mendu ML, Miller WG, Moxey-Mims MM, Roberts GV, St Peter WL, Warfield C, Powe NR. A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. Am J Kidney Dis 2022; 79:268-288.e1. [PMID: 34563581 DOI: 10.1053/j.ajkd.2021.08.003] [Citation(s) in RCA: 279] [Impact Index Per Article: 139.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In response to a national call for re-evaluation of the use of race in clinical algorithms, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) established a Task Force to reassess inclusion of race in the estimation of glomerular filtration rate (GFR) in the United States and its implications for diagnosis and management of patients with, or at risk for, kidney diseases. PROCESS & DELIBERATIONS The Task Force organized its activities over 10 months in phases to (1) clarify the problem and evidence regarding GFR estimating equations in the United States (described previously in an interim report), and, in this final report, (2) evaluate approaches to address use of race in GFR estimation, and (3) provide recommendations. We identified 26 approaches for the estimation of GFR that did or did not consider race and narrowed our focus, by consensus, to 5 of those approaches. We holistically evaluated each approach considering 6 attributes: assay availability and standardization; implementation; population diversity in equation development; performance compared with measured GFR; consequences to clinical care, population tracking, and research; and patient centeredness. To arrive at a unifying approach to estimate GFR, we integrated information and evidence from many sources in assessing strengths and weaknesses in attributes for each approach, recognizing the number of Black and non-Black adults affected. RECOMMENDATIONS (1) For US adults (>85% of whom have normal kidney function), we recommend immediate implementation of the CKD-EPI creatinine equation refit without the race variable in all laboratories in the United States because it does not include race in the calculation and reporting, included diversity in its development, is immediately available to all laboratories in the United States, and has acceptable performance characteristics and potential consequences that do not disproportionately affect any one group of individuals. (2) We recommend national efforts to facilitate increased, routine, and timely use of cystatin C, especially to confirm estimated GFR in adults who are at risk for or have chronic kidney disease, because combining filtration markers (creatinine and cystatin C) is more accurate and would support better clinical decisions than either marker alone. If ongoing evidence supports acceptable performance, the CKD-EPI eGFR-cystatin C (eGFRcys) and eGFR creatinine-cystatin C (eGFRcr-cys_R) refit without the race variables should be adopted to provide another first-line test, in addition to confirmatory testing. (3) Research on GFR estimation with new endogenous filtration markers and on interventions to eliminate race and ethnic disparities should be encouraged and funded. An investment in science is needed for newer approaches that generate accurate, unbiased, and precise GFR measurement and estimation without the inclusion of race, and that promote health equity and do not generate disparate care. IMPLEMENTATION This unified approach, without specification of race, should be adopted across the United States. High-priority and multistakeholder efforts should implement this solution.
Collapse
Affiliation(s)
- Cynthia Delgado
- Nephrology Section, San Francisco Veterans Affairs Medical Center and Division of Nephrology, University of California San Francisco, San Francisco, California.
| | - Mukta Baweja
- Nephrology Division, Department of Medicine and Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Crystal A Gadegbeku
- Department of Nephrology and Hypertension, Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Mallika L Mendu
- Division of Renal Medicine and Office of the Chief Medical Officer, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Marva M Moxey-Mims
- Division of Nephrology, Children's National Hospital, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Glenda V Roberts
- External Relations and Patient Engagement, Kidney Research Institute and Center for Dialysis Innovation, University of Washington, Seattle, Washington
| | - Wendy L St Peter
- College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | | | - Neil R Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and University of California San Francisco, San Francisco, California.
| |
Collapse
|
29
|
Okawa T, Mizuno T, Hanabusa S, Ikeda T, Mizokami F, Koseki T, Takahashi K, Yuzawa Y, Tsuboi N, Yamada S, Kameya Y. Prediction model of acute kidney injury induced by cisplatin in older adults using a machine learning algorithm. PLoS One 2022; 17:e0262021. [PMID: 35041690 PMCID: PMC8765666 DOI: 10.1371/journal.pone.0262021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background
Early detection and prediction of cisplatin-induced acute kidney injury (Cis-AKI) are essential for the management of patients on chemotherapy with cisplatin. This study aimed to evaluate the performance of a prediction model for Cis-AKI.
Methods
Japanese patients, who received cisplatin as the first-line chemotherapy at Fujita Health University Hospital, were enrolled in the study. The main metrics for evaluating the machine learning model were the area under the curve (AUC), accuracy, precision, recall, and F-measure. In addition, the rank of contribution as a predictive factor of Cis-AKI was determined by machine learning.
Results
A total of 1,014 and 226 patients were assigned to the development and validation data groups, respectively. The current prediction model showed the highest performance in patients 65 years old and above (AUC: 0.78, accuracy: 0.77, precision: 0.38, recall: 0.70, F-measure: 0.49). The maximum daily cisplatin dose and serum albumin levels contributed the most to the prediction of Cis-AKI.
Conclusion
Our prediction model for Cis-AKI performed effectively in older patients.
Collapse
|
30
|
Marzinke MA, Greene DN, Bossuyt PM, Chambliss AB, Cirrincione LR, McCudden CR, Melanson SEF, Noguez JH, Patel K, Radix AE, Takwoingi Y, Winston-McPherson G, Young BA, Hoenig MP. Limited Evidence for Use of a Black Race Modifier in eGFR Calculations: A Systematic Review. Clin Chem 2021; 68:521-533. [DOI: 10.1093/clinchem/hvab279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Commonly used estimated glomerular filtration rate (eGFR) equations include a Black race modifier (BRM) that was incorporated during equation derivation. Race is a social construct, and a poorly characterized variable that is applied inconsistently in clinical settings. The BRM results in higher eGFR for any creatinine concentration, implying fundamental differences in creatinine production or excretion in Black individuals compared to other populations. Equations without inclusion of the BRM have the potential to detect kidney disease earlier in patients at the greatest risk of chronic kidney disease (CKD), but also has the potential to over-diagnose CKD or impact downstream clinical interventions. The purpose of this study was to use an evidence- based approach to systematically evaluate the literature relevant to the performance of the eGFR equations with and without the BRM and to examine the clinical impact of the use or removal.
Content
PubMed and Embase databases were searched for studies comparing measured GFR to eGFR in racially diverse adult populations using the Modification of Diet in Renal Disease or the 2009-Chronic Kidney Disease Epidemiology Collaboration-creatinine equations based on standardized creatinine measurements. Additionally, we searched for studies comparing clinical use of eGFR calculated with and without the BRM. 8,632 unique publications were identified; an additional 3 studies were added post-hoc. In total, 96 studies were subjected to further analysis and 44 studies were used to make a final assessment.
Summary
There is limited published evidence to support the use of a BRM in eGFR equations.
Collapse
Affiliation(s)
- Mark A Marzinke
- Departments of Pathology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dina N Greene
- Department of Laboratory Medicine and Pathology; University of Washington, Seattle, WA; Kaiser Permanente, Renton, WA
| | - Patrick M Bossuyt
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Christopher R McCudden
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital; University of Ottawa; Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada
| | - Stacy E F Melanson
- Department of Pathology; Brigham and Women’s Hospital; Harvard Medical School, Boston, MA
| | - Jaime H Noguez
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Khushbu Patel
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Asa E Radix
- Callen-Lorde Community Health Center, New York, NY
| | - Yemisi Takwoingi
- Institute of Applied Health Research,University of Birmingham and NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | | | - Bessie A Young
- Office of Healthcare Equity, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Melanie P Hoenig
- Renal Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| |
Collapse
|
31
|
Delgado C, Baweja M, Crews DC, Eneanya ND, Gadegbeku CA, Inker LA, Mendu ML, Miller WG, Moxey-Mims MM, Roberts GV, St. Peter WL, Warfield C, Powe NR. A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. J Am Soc Nephrol 2021; 32:2994-3015. [PMID: 34556489 PMCID: PMC8638402 DOI: 10.1681/asn.2021070988] [Citation(s) in RCA: 145] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/05/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND In response to a national call for re-evaluation of the use of race in clinical algorithms, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) established a Task Force to reassess inclusion of race in the estimation of GFR in the United States and its implications for diagnosis and management of patients with, or at risk for, kidney diseases. PROCESS DELIBERATIONS The Task Force organized its activities over 10 months in phases to ( 1 ) clarify the problem and evidence regarding eGFR equations in the United States (described previously in an interim report), and, in this final report, ( 2 ) evaluate approaches to address use of race in GFR estimation, and ( 3 ) provide recommendations. We identified 26 approaches for the estimation of GFR that did or did not consider race and narrowed our focus, by consensus, to five of those approaches. We holistically evaluated each approach considering six attributes: assay availability and standardization; implementation; population diversity in equation development; performance compared with measured GFR; consequences to clinical care, population tracking, and research; and patient centeredness. To arrive at a unifying approach to estimate GFR, we integrated information and evidence from many sources in assessing strengths and weaknesses in attributes for each approach, recognizing the number of Black and non-Black adults affected. RECOMMENDATIONS ( 1 ) For US adults (>85% of whom have normal kidney function), we recommend immediate implementation of the CKD-EPI creatinine equation refit without the race variable in all laboratories in the United States because it does not include race in the calculation and reporting, included diversity in its development, is immediately available to all laboratories in the United States, and has acceptable performance characteristics and potential consequences that do not disproportionately affect any one group of individuals. ( 2 ) We recommend national efforts to facilitate increased, routine, and timely use of cystatin C, especially to confirm eGFR in adults who are at risk for or have CKD, because combining filtration markers (creatinine and cystatin C) is more accurate and would support better clinical decisions than either marker alone. If ongoing evidence supports acceptable performance, the CKD-EPI eGFR-cystatin C (eGFRcys) and eGFR creatinine-cystatin C (eGFRcr-cys_R) refit without the race variables should be adopted to provide another first-line test, in addition to confirmatory testing. ( 3 ) Research on GFR estimation with new endogenous filtration markers and on interventions to eliminate race and ethnic disparities should be encouraged and funded. An investment in science is needed for newer approaches that generate accurate, unbiased, and precise GFR measurement and estimation without the inclusion of race, and that promote health equity and do not generate disparate care. IMPLEMENTATION This unified approach, without specification of race, should be adopted across the United States. High-priority and multistakeholder efforts should implement this solution.
Collapse
Affiliation(s)
- Cynthia Delgado
- Nephrology Section, San Francisco Veterans Affairs Medical Center and Division of Nephrology, University of California San Francisco, San Francisco, California
| | - Mukta Baweja
- Nephrology Division, Department of Medicine and Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nwamaka D. Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Crystal A. Gadegbeku
- Department of Nephrology and Hypertension, Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Lesley A. Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Mallika L. Mendu
- Division of Renal Medicine and Office of the Chief Medical Officer, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - W. Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Marva M. Moxey-Mims
- Division of Nephrology, Children’s National Hospital, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Glenda V. Roberts
- External Relations and Patient Engagement, Kidney Research Institute and Center for Dialysis Innovation, University of Washington, Seattle, Washington
| | | | | | - Neil R. Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and University of California San Francisco, San Francisco, California
| |
Collapse
|
32
|
Affiliation(s)
- Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, MA 02111, USA.
| | - Neil R Powe
- Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| |
Collapse
|