Khan Amir, Wang Shu, Barry Kathryn Hughes, Onukwugha Eberechukwu, Phelan Michael, Choudhry Rehan, Siddiqui Mohummad Minhaj
Division of Urology, Department of Surgery, School of Medicine, University of Maryland Baltimore, MD, USA.
Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine New York, NY, USA.
Am J Clin Exp Urol. 2024 Dec 15;12(6):389-398. doi: 10.62347/DOCH1460. eCollection 2024.
The estimated glomerular filtration rate (eGFR) has historically been calculated with a race-coefficient multiplier (RCM); however, the RCM has been broadly criticized as inaccurate and a potential contributor to exacerbating disparities. We evaluated the impact of the RCM on eGFR and examined the 30-day post-cystectomy complications in a muscle-invasive bladder cancer cohort.
We retrospectively analyzed patients diagnosed with MIBC who underwent cystectomy in the ACS NSQIP database from 2006 to 2020 using CPT and ICD codes. The eGFR was computed using the Modification of Diet in Renal Diseases equation which has RCM = 1.212 for black patients. Using the race data field, patients were categorized into Black and non-Black. The eGFR cut-off of 60 mL/min/1.73 m was chosen for patient stratification because it represents a key clinical threshold in the classification of chronic kidney disease and influences various care decisions such as chemotherapy choice. Subsequently, we examined the 30-day post-cystectomy cardiovascular and pulmonary (CV&P) complications in these patients stratified by their eGFR using descriptive statistics and a multivariable logistic regression model.
The application of the RCM to estimate eGFR in the Black cohort increased the mean eGFR from 57.8 to 70.0 ml/min/1.73 m (P = 0.001) which led to a 17.3% (45.6% vs 62.9%, P = 0.001) increase in the proportion of Black patients with eGFR≥60 ml/min/1.73 m. The rate of CV&P complications post-cystectomy among this group of 17.3% of patients in the Black cohort was 7.6% compared to a 4.3% complication rate among a non-Black cohort matched for similar eGFR for whom RCM was not applied (P = 0.06). Black patients in this RCM-dependent category of eGFR≥60 mL/min/1.73 m had higher adjusted odds of developing 30-day post cystectomy CV&P complications compared to eGFR-matched non-Black patients (OR = 2.2, 95% CI = 1.13-4.31, P = 0.02).
In this study, we found that inclusion of RCM in the eGFR significantly increases the proportion of Black patients with eGFR≥60. This RCM might also be associated with higher post-cystectomy CV&P complications; therefore, future studies are needed to evaluate the implications of race-based algorithms on outcomes.
既往估算肾小球滤过率（eGFR）时使用了种族系数乘数（RCM）；然而，RCM受到广泛批评，认为其不准确且可能加剧差异。我们评估了RCM对eGFR的影响，并在肌肉浸润性膀胱癌队列中研究了膀胱切除术后30天的并发症情况。
我们使用CPT和ICD编码，对2006年至2020年在ACS NSQIP数据库中接受膀胱切除术的确诊为MIBC的患者进行了回顾性分析。使用肾脏病饮食改良方程计算eGFR，该方程对黑人患者的RCM = 1.212。利用种族数据字段，将患者分为黑人组和非黑人组。选择60 mL/min/1.73 m²的eGFR临界值进行患者分层，因为它代表了慢性肾脏病分类中的关键临床阈值，并影响诸如化疗选择等各种护理决策。随后，我们使用描述性统计和多变量逻辑回归模型，研究了这些按eGFR分层的患者膀胱切除术后30天的心血管和肺部（CV&P）并发症情况。
在黑人队列中应用RCM估算eGFR，使平均eGFR从57.8提高到70.0 ml/min/1.73 m²（P = 0.001），这导致eGFR≥60 ml/min/1.73 m²的黑人患者比例增加了17.3%（45.6%对62.9%，P = 0.001）。在这17.3%的黑人队列患者中，膀胱切除术后CV&P并发症发生率为7.6%，而在未应用RCM、eGFR相似的非黑人队列中，并发症发生率为4.3%（P = 0.06）。与eGFR匹配的非黑人患者相比，在eGFR≥60 mL/min/1.73 m²且依赖RCM的这一类别中的黑人患者，发生膀胱切除术后30天CV&P并发症的调整后几率更高（OR = 2.2，95% CI = 1.13 - 4.31，P = 0.02）。
在本研究中，我们发现将RCM纳入eGFR计算中显著增加了eGFR≥60的黑人患者比例。这种RCM也可能与膀胱切除术后更高的CV&P并发症相关；因此，需要进一步研究来评估基于种族的算法对预后的影响。
