Effect of Adopting the New Race-Free 2021 Chronic Kidney Disease Epidemiology Collaboration Estimated Glomerular Filtration Rate Creatinine Equation on Racial Differences in Kidney Disease Progression Among People With Human Immunodeficiency Virus: An Observational Study

Anthony N Muiru; Erin Madden; Rebecca Scherzer; Michael A Horberg; Michael J Silverberg; Marina B Klein; Angel M Mayor; M John Gill; Sonia Napravnik; Heidi M Crane; Vincent C Marconi; John R Koethe; Alison G Abraham; Keri N Althoff; Gregory M Lucas; Richard D Moore; Michael G Shlipak; Michelle M Estrella

doi:10.1093/cid/ciac731

Effect of Adopting the New Race-Free 2021 Chronic Kidney Disease Epidemiology Collaboration Estimated Glomerular Filtration Rate Creatinine Equation on Racial Differences in Kidney Disease Progression Among People With Human Immunodeficiency Virus: An Observational Study

Clin Infect Dis. 2023 Feb 8;76(3):461-468. doi: 10.1093/cid/ciac731.

Authors

Anthony N Muiru^{1

2}, Erin Madden^{1

3}, Rebecca Scherzer^{1

3}, Michael A Horberg⁴, Michael J Silverberg⁵, Marina B Klein⁶, Angel M Mayor⁷, M John Gill⁸, Sonia Napravnik⁹, Heidi M Crane¹⁰, Vincent C Marconi^{11

12}, John R Koethe¹³, Alison G Abraham^{14

15}, Keri N Althoff¹⁵, Gregory M Lucas¹⁶, Richard D Moore¹⁶, Michael G Shlipak^{1

3}, Michelle M Estrella^{1

2

3}

Affiliations

¹ Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA.
² Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA.
³ San Francisco VA Health Care System, San Francisco, California, USA.
⁴ Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA.
⁵ Kaiser Permanente Northern California, Oakland, California, USA.
⁶ Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.
⁷ Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamon, Puerto Rico, USA.
⁸ Department of Medicine, University of Calgary, Southern Alberta HIV Clinic, Calgary, Alberta, Canada.
⁹ Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁰ Division of Allergy and Infectious Diseases, Center for AIDS Research, University of Washington, Seattle, Washington, USA.
¹¹ Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
¹² Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
¹³ Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁴ Department of Epidemiology, School of Public Health University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
¹⁵ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
¹⁶ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Abstract

Background: The impact of adopting a race-free estimated glomerular filtration rate (eGFR) creatinine (eGFRcr) equation on racial differences in chronic kidney disease (CKD) progression among people with human immunodeficiency virus (PWH) is unknown.

Methods: We defined eGFR stages using the original race-adjusted Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFRcr equation and the new race-free CKD-EPI eGFRcr equation. We then estimated 5-year probabilities of transitioning from baseline kidney function to more advanced eGFR stages and examined the association of race (black vs white) with rates of CKD progression using Markov models.

Results: With the race-adjusted eGFRcr equation, black participants (n = 31 298) had a lower risk of progressing from eGFR stage 1 to 2 (hazard ratio [HR], 0.77; 95% confidence interval [CI], .73-.82), an equal risk of progressing from stage 2 to 3 (1.00; .92-.07) and a 3-fold risk of progressing from stage 3 to 4 or 5 (3.06; 2.60-3.62), compared with white participants (n = 27 542). When we used the race-free eGFRcr equation, 16% of black participants were reclassified into a more severe eGFR stage at baseline. The reclassified black individuals had a higher prevalence of CKD risk factors than black PWH who were not reclassified. With the race-free eGFRcr equation, black participants had a higher risk of disease progression across all eGFR stages than white participants.

Conclusions: The original eGFRcr equation systematically masked a subgroup of black PWH who are at high-risk of CKD progression. The new race-free eGFRcr equation unmasks these individuals and may allow for earlier detection and management of CKD.

Keywords: CKD; ESKD; HIV; eGFR; race.

Publication types

Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Black or African American
Creatinine
Disease Progression
Glomerular Filtration Rate
HIV Infections* / complications
HIV Infections* / ethnology
Humans
Kidney
Race Factors
Renal Insufficiency, Chronic* / epidemiology
Renal Insufficiency, Chronic* / ethnology
White

Substances

Creatinine

Abstract

Publication types

MeSH terms

Substances

Grants and funding