Hasley Hunter L, Iarajuli Teona, Nguyen Jennifer, Thiemann Daniel, Malik Martin, Roth Jacquelyn, Raver Michael, Stifelman Michael, Munver Ravi, Ahmed Mutahar, Yerram Nitin
Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA.
Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA.
Urol Ann. 2024 Jul-Sep;16(3):221-226. doi: 10.4103/ua.ua_7_24. Epub 2024 Jul 3.
In estimated glomerular filtration rate equations (eGFR), the race multiplier (RM) yields greater eGFR values and may assign less severe chronic kidney disease (CKD) stages to black individuals. When deciding on appropriateness for partial nephrectomy (PN), patients with CKD are often considered a relative or absolute indication. We hypothesize that the eGFR RM may have ramifications for patients being counseled for radical nephrectomy (RN) versus PN to manage their renal tumor.
We utilized prospective and retrospective, IRB-approved single-center databases to select patients who underwent PN or RN between 2016 and 2022. Demographics, preoperative risk factors, preoperative eGFR, and surgical management were collected. Descriptive statistics and two-tailed difference of proportion tests compared the percentage of patients with CKD who underwent nephrectomy.
This cohort included 1137 patients who underwent RN or PN, including 74 (6.5%) Black patients and 93.5% ( = 1063) non-Black patients. There was no statistically significant difference between the eGFR of Black and non-Black individuals using the Modification of Diet in Renal Disease equation ( = 0.24) or Chronic Kidney Disease Epidemiology Collaboration 2009 (CKD-EPI 2009) ( = 0.45); however, there was statistically significant difference in eGFR between sample populations when using CKD-EPI 2021 ( = 0.0055). Of the Black patient cohort, 16.2% of patients reclassified to a worse CKD class using CKD-EPI 2021, including 9.5% of Black patients reclassified to CKD3a or worse, and 14.6% of all patients (Black and non-Black) reclassified to a different CKD class under the CKD-EPI 2021 equation.
There are quantitative differences in the evaluation of eGFR when utilizing different equations that may impact clinical considerations and health equity outcomes for nephrectomy across racial groups.
在估计肾小球滤过率方程（eGFR）中，种族乘数（RM）会得出更高的eGFR值，并且可能会将黑人个体的慢性肾脏病（CKD）分期判定为不那么严重。在决定是否适合进行部分肾切除术（PN）时，CKD患者通常被视为相对或绝对指征。我们假设eGFR种族乘数可能会对接受根治性肾切除术（RN）与PN以治疗肾肿瘤的患者咨询产生影响。
我们利用经机构审查委员会（IRB）批准的前瞻性和回顾性单中心数据库，选取2016年至2022年间接受PN或RN的患者。收集人口统计学、术前危险因素、术前eGFR和手术管理信息。描述性统计和双尾比例差异检验比较了接受肾切除术的CKD患者百分比。
该队列包括1137例接受RN或PN的患者，其中74例（6.5%）为黑人患者，93.5%（=1063）为非黑人患者。使用肾脏疾病饮食改良方程（=0.24）或慢性肾脏病流行病学协作组2009年（CKD-EPI 2009）方程时，黑人和非黑人个体的eGFR之间无统计学显著差异（=0.45）；然而，使用CKD-EPI 2021方程时，样本人群之间的eGFR存在统计学显著差异（=0.0055）。在黑人患者队列中，16.2%的患者使用CKD-EPI 2021重新分类为更差的CKD等级，其中9.5%的黑人患者重新分类为CKD3a或更差，并且在CKD-EPI 2021方程下，所有患者（黑人和非黑人）中有14.6%重新分类为不同的CKD等级。
使用不同方程评估eGFR时存在数量差异，这可能会影响不同种族群体肾切除术的临床考量和健康公平结果。
