Rungkitwattanakul Dhakrit, Evans Ebony, Brown Ewanna, Patterson Kent, Chaijamorn Weerachai, Charoensareerat Taniya, Belrhiti Sanaa, Nwaogwugwu Uzoamaka, Mere Constance
Department of Clinical and Administrative Pharmacy Science, Howard University College of Pharmacy, Washington, DC 20059, USA.
Howard University College of Pharmacy, Washington, DC 20059, USA.
Pharmacy (Basel). 2025 Apr 2;13(2):52. doi: 10.3390/pharmacy13020052.
In 2021, the National Kidney Foundation-American Society of Nephrology (NKF-ASN) recommended the use of the 2021 refit equation without race; however, the effect of the removal is unclear. Our research aimed to examine the implications of antidiabetic dosing and eligibility on the new 2021 equation among Black patients.
This is a retrospective analysis of patients receiving care at the diabetes treatment center (DTC) of an academic medical center. Estimated glomerular filtration rates (eGFRs) based on serum creatinine were calculated using the 2009 and 2021 CKD-EPI equations. A Monte Carlo simulation was performed to create 10,000 virtual patients. Dosing simulations based on each estimate of kidney function were performed for antidiabetics based on product labeling. The proportion and percentage of patients who were eligible based on the estimates were calculated.
The percentages of patients ineligible for metformin based on the estimates from the 2009 and 2021 CKD-EPI equations at the DTC were comparable (8.02% and 8.36%, respectively). In our 10,000 simulated virtual patients, the percentage of ineligibility increased only by 1%. For the GFR cut points of 20 mL/min and 25 mL/min, the rates of ineligibility were similar in our cohort and simulated patients.
The exclusion of race from the 2021 CKD-EPI equation may slightly reduce medication eligibility among Black patients.
2021年，美国国家肾脏基金会-美国肾脏病学会（NKF-ASN）建议使用不考虑种族因素的2021年修订方程；然而，去除种族因素的影响尚不清楚。我们的研究旨在探讨黑人患者中抗糖尿病药物剂量调整和适用标准对新的2021年方程的影响。
这是一项对在一所学术医疗中心的糖尿病治疗中心（DTC）接受治疗的患者进行的回顾性分析。基于血清肌酐的估计肾小球滤过率（eGFR）使用2009年和2021年的CKD-EPI方程进行计算。进行了蒙特卡洛模拟以创建10000名虚拟患者。根据产品标签，针对每种肾功能估计值进行了抗糖尿病药物的剂量模拟。计算了基于这些估计值符合条件的患者比例和百分比。
根据DTC的2009年和2021年CKD-EPI方程估计，不符合使用二甲双胍条件的患者百分比相当（分别为8.02%和8.36%）。在我们的10000名模拟虚拟患者中，不符合条件的百分比仅增加了1%。对于20 mL/min和25 mL/min的肾小球滤过率切点，我们队列中的不符合条件率与模拟患者相似。
2021年CKD-EPI方程中排除种族因素可能会略微降低黑人患者的用药适用率。
