探讨种族乘数在估计肾小球滤过率计算中的应用对非裔美国人护理结局的潜在影响。
Examining the Potential Impact of Race Multiplier Utilization in Estimated Glomerular Filtration Rate Calculation on African-American Care Outcomes.
机构信息
Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
J Gen Intern Med. 2021 Feb;36(2):464-471. doi: 10.1007/s11606-020-06280-5. Epub 2020 Oct 15.
BACKGROUND
Advancing health equity entails reducing disparities in care. African-American patients with chronic kidney disease (CKD) have poorer outcomes, including dialysis access placement and transplantation. Estimated glomerular filtration rate (eGFR) equations, which assign higher eGFR values to African-American patients, may be a mechanism for inequitable outcomes. Electronic health record-based registries enable population-based examination of care across racial groups.
OBJECTIVE
To examine the impact of the race multiplier for African-Americans in the CKD-EPI eGFR equation on CKD classification and care delivery.
DESIGN
Cross-sectional study SETTING: Two large academic medical centers and affiliated community primary care and specialty practices.
PARTICIPANTS
A total of 56,845 patients in the Partners HealthCare System CKD registry in June 2019, among whom 2225 (3.9%) were African-American.
MEASUREMENTS
Exposures included race, age, sex, comorbidities, and eGFR. Outcomes were transplant referral and dialysis access placement.
RESULTS
Of 2225 African-American patients, 743 (33.4%) would hypothetically be reclassified to a more severe CKD stage if the race multiplier were removed from the CKD-EPI equation. Similarly, 167 of 687 (24.3%) would be reclassified from stage 3B to stage 4. Finally, 64 of 2069 patients (3.1%) would be reassigned from eGFR > 20 ml/min/1.73 m to eGFR ≤ 20 ml/min/1.73 m, meeting the criterion for accumulating kidney transplant priority. Zero of 64 African-American patients with an eGFR ≤ 20 ml/min/1.73 m after the race multiplier was removed were referred, evaluated, or waitlisted for kidney transplant, compared to 19.2% of African-American patients with eGFR ≤ 20 ml/min/1.73 m with the default CKD-EPI equation.
LIMITATIONS
Single healthcare system in the Northeastern United States and relatively small African-American patient cohort may limit generalizability.
CONCLUSIONS
Our study reveals a meaningful impact of race-adjusted eGFR on the care provided to the African-American CKD patient population.
背景
推进卫生公平需要减少医疗服务中的差异。患有慢性肾脏病（CKD）的非裔美国患者的治疗结果较差，包括透析通路的建立和移植。肾小球滤过率（eGFR）估算方程将更高的 eGFR 值分配给非裔美国患者，这可能是非公平结果的一个机制。基于电子健康记录的登记系统可以对不同种族群体的护理进行基于人群的检查。
目的
研究 CKD-EPI eGFR 方程中针对非裔美国人的种族乘数对 CKD 分类和护理提供的影响。
设计
横断面研究
设置
两家大型学术医疗中心及其附属社区初级保健和专业实践。
参与者
2019 年 6 月，在 Partners HealthCare 系统 CKD 登记处的 56845 名患者中，其中 2225 名（3.9%）是非裔美国人。
测量
暴露因素包括种族、年龄、性别、合并症和 eGFR。结果为移植推荐和透析通路建立。
结果
在 2225 名非裔美国患者中，如果从 CKD-EPI 方程中去除种族乘数，743 名（33.4%）患者将被重新分类为更严重的 CKD 阶段。同样，687 名患者中的 167 名（24.3%）将从 3B 期重新分类为 4 期。最后，2069 名患者中的 64 名（3.1%）将从 eGFR >20ml/min/1.73m 重新分配到 eGFR ≤20ml/min/1.73m，符合累积肾脏移植优先权的标准。在去除种族乘数后，64 名 eGFR ≤20ml/min/1.73m 的非裔美国患者中没有一人被推荐、评估或列入肾脏移植候补名单，而在使用默认 CKD-EPI 方程的情况下，eGFR ≤20ml/min/1.73m 的非裔美国患者中有 19.2%被推荐、评估或列入肾脏移植候补名单。
局限性
美国东北部单一医疗系统和相对较小的非裔美国患者队列可能限制了其普遍性。
结论
我们的研究揭示了种族调整后的 eGFR 对非裔美国 CKD 患者群体提供的护理的重大影响。
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