Abate Mersema, Jandovitz Nicholas, Hirsch Jamie S, Breslin Nadine, Lau Lawrence, Fahmy Ahmed E, Jhaveri Kenar D, Richardson Safiya, Alsalmay Yaser, Baez Anthony, Mishra Akash, Bolourani Siavash, Miyara Santiago J, Winnick Aaron, Nair Gayatri, Bhaskaran Madhu C, Grodstein Elliot, Kressel Adam M, Teperman Lewis W, Molmenti Ernesto P, Nair Vinay
Department of Medicine, Norwell Health, Manhasset, NY, USA.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA.
Clin Kidney J. 2021 Dec 23;15(5):942-950. doi: 10.1093/ckj/sfab287. eCollection 2022 May.
Race coefficients of estimated glomerular filtration rate (eGFR) formulas may be partially responsible for racial inequality in preemptive listing for kidney transplantation.
We used the Scientific Registry of Transplant Recipients database to evaluate differences in racial distribution of preemptive listing before and after application of the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) race coefficients to all preemptively listed non-Black kidney transplant candidates (eGFR modulation). Odds of preemptive listing were calculated by race, with Black as the reference before and after eGFR modulation. Variables known to influence preemptive listing were included in the model.
Among 385 087 kidney-alone transplant candidates from 1 January 2010 to 2 December 2020, 118 329 (30.7%) candidates were identified as preemptively listed (71.7% White, 19% Black, 7.8% Asian, 0.6% multi-racial, 0.6% Native American and 0.3% Pacific Islander). After eGFR modulation, non-Black patients with an eGFR ≥20 mL/min/1.73 m were removed. Compared with Black candidates, the adjusted odds of preemptive listing for White candidates decreased from 2.01 [95% confidence interval (95% CI) 1.78-2.26] before eGFR modulation to 1.18 (95% CI 1.0-1.39; P = 0.046) with the MDRD and 1.37 (95% CI 1.18-1.58) with the CKD-EPI equations after adjusting for race coefficients.
Removing race coefficients in GFR estimation formulas may result in a more equitable distribution of Black candidates listed earlier on a preemptive basis.
估计肾小球滤过率（eGFR）公式中的种族系数可能部分导致了肾移植优先排队名单中的种族不平等。
我们使用移植受者科学注册数据库，评估在对所有优先排队的非黑人肾移植候选人应用肾脏病膳食改良（MDRD）和慢性肾脏病流行病学协作组（CKD-EPI）种族系数前后（eGFR调整），优先排队的种族分布差异。按种族计算优先排队的几率，以黑人作为eGFR调整前后的参照。模型中纳入了已知影响优先排队的变量。
在2010年1月1日至2020年12月2日的385087名单纯肾移植候选人中，118329名（30.7%）候选人被确定为优先排队（71.7%为白人，19%为黑人，7.8%为亚洲人，0.6%为多种族，0.6%为美洲原住民，0.3%为太平洋岛民）。eGFR调整后，eGFR≥20 mL/min/1.73 m²的非黑人患者被排除。与黑人候选人相比，白人候选人优先排队的调整后几率在eGFR调整前为2.01[95%置信区间（95%CI）1.78 - 2.26]，应用MDRD种族系数后降至1.18（95%CI 1.0 - 1.39；P = 0.046），应用CKD-EPI方程后为1.37（95%CI 1.18 - 1.58）。
在肾小球滤过率估计公式中去除种族系数可能会使更早被优先排队的黑人候选人分布更加公平。
