University of Michigan, Ann Arbor, Michigan.
Willis Knighton Health System, Shreveport, Louisiana.
Clin J Am Soc Nephrol. 2021 Oct;16(10):1552-1559. doi: 10.2215/CJN.05490421.
Current race-based eGFR calculators assign a higher eGFR value to Black patients, which could affect the care of kidney transplant candidates and potential living donors.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a survey of staff at adult kidney transplant centers in the United States (December 17, 2020 to February 28, 2021) to assess opinions on use of race-based eGFR equations for waitlisting and living donor candidate evaluation, availability of serum cystatin C testing and measured GFR, and related practices.
Respondents represented 57% (124 of 218) of adult kidney transplant programs, and the responding centers conducted 70% of recent kidney transplant volume. Most (93%) programs use serum creatinine-based eGFR for listing candidates. However, only 6% of respondents felt that current race-based eGFR calculators are appropriate, with desire for change grounded in concerns for promotion of health care disparities by current equations and inaccuracies in reporting of race. Most respondents (70%) believed that elimination of race would allow more preemptive waitlisting for Black patients, but a majority (79%) also raised concerns that such an approach could incur harms. More than one third of the responding programs lacked or were unsure of availability of testing for cystatin C or measured GFR. At this time, 40% of represented centers did not plan to remove race from eGFR calculators, 46% were planning to remove, and 15% had already done so. There was substantial variability in eGFR reporting and listing of multiracial patients with some Black ancestry. There was no difference in GFR acceptance thresholds for Black versus non-Black living donors.
This national survey highlights a broad consensus that extant approaches to GFR estimation are unsatisfactory, but it also identified a range of current opinions.
当前基于种族的 eGFR 计算器为黑人患者分配了更高的 eGFR 值，这可能会影响到肾移植候选人和潜在活体供者的护理。
设计、设置、参与者和测量：我们对美国成人肾移植中心的工作人员进行了一项调查（2020 年 12 月 17 日至 2021 年 2 月 28 日），以评估他们对种族相关 eGFR 方程在候补名单和活体供者候选评估中的使用、血清胱抑素 C 检测和测量肾小球滤过率的可用性以及相关实践的意见。
应答者代表了 57%（218 名中的 124 名）的成人肾移植项目，而参与调查的中心进行了最近 70%的肾移植量。大多数（93%）项目使用血清肌酐的 eGFR 对候选者进行列表。然而，只有 6%的应答者认为当前基于种族的 eGFR 计算器是合适的，他们希望改变目前的公式，因为担心这些公式会促进医疗保健方面的差异，并对种族的报告存在不准确。大多数应答者（70%）认为消除种族会允许更多的黑人患者提前候补名单，但大多数（79%）也担心这种方法可能会造成伤害。超过三分之一的应答项目缺乏或不确定是否可以进行胱抑素 C 或测量的 GFR 检测。目前，40%的代表中心不打算从 eGFR 计算器中删除种族，46%的中心计划删除，15%的中心已经这样做了。在报告和列出具有一定黑人血统的多种族患者的 eGFR 方面存在很大差异。黑人与非黑人活体供者的 GFR 接受阈值没有差异。
这项全国性调查突出表明，广泛共识认为目前的 GFR 估计方法并不令人满意，但也确定了一系列当前的意见。
