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Updated: Oct 19, 2025

Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Race, Genetic Ancestry, and Estimating Kidney Function in CKD.
Chi-Yuan Hsu1, Wei Yang1, Rishi V Parikh1
1From the Division of Nephrology, Department of Medicine (C.H., A.N.M., A.S.G.), and the Departments of Epidemiology and Biostatistics (A.S.G.), University of California, San Francisco, San Francisco, the Division of Research, Kaiser Permanente Northern California, Oakland (C.H., R.V.P., T.C.T., A.S.G.), the Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena (A.S.G.), and the Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto (A.S.G.) - all in California; the Department of Biostatistics, Epidemiology, and Informatics and the Center for Clinical Epidemiology and Biostatistics (W.Y., J.W., H.I.F.), the Division of Division of Renal-Electrolyte and Hypertension (D.L.C.), and the Department of Medicine (R.R.T.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (A.H.A., J.H., K.T.M.) and the Tulane University Translational Science Institute (A.H.A., J.H., K.T.M.), New Orleans; the Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, and the Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore (T.K.C.), and the Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda (A.P.) - all in Maryland; the Division of Nephrology, Department of Internal Medicine, Wayne State University, Detroit (M.J.M.); the Division of Nephrology, Department of Medicine, University of Illinois at Chicago (J.P.L.), and the Section of General Internal Medicine, Department of Medicine, University of Chicago (M.R.S.) - both in Chicago; the Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson (T.S.); the Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston (S.S.W.); and the Division of Nephrology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.W.).
Estimating glomerular filtration rate (GFR) without race is crucial. Using cystatin C for GFR estimation in Black adults provides accurate results, unlike race-based serum creatinine equations.
Area of Science:
- Nephrology
- Biochemistry
- Genetics
Background:
- The use of race in estimating glomerular filtration rate (GFR) is controversial.
- Accurate GFR estimation without race is needed.
Purpose of the Study:
- To evaluate alternative methods for accurate GFR estimation in adults.
- To assess GFR estimation using serum creatinine and cystatin C, with and without race or genetic ancestry.
Main Methods:
- Cross-sectional analysis of 1248 adults with chronic kidney disease.
- Collected data on participant-reported race, genetic ancestry, serum creatinine, cystatin C, and urinary creatinine.
- Compared GFR estimating equations with and without race/ancestry.
Main Results:
- Omitting race from serum creatinine-based GFR equations led to underestimation and lower accuracy in Black participants.
- Incorporating genetic ancestry instead of race yielded similar GFR estimates.
- Using cystatin C for GFR estimation in Black participants did not require race or ancestry for accurate and unbiased results.
Conclusions:
- Serum creatinine-based GFR estimation without race/ancestry causes misclassification.
- GFR estimation using cystatin C achieves accurate results without race-based adjustments.
- Cystatin C offers a viable alternative to race-inclusive GFR estimation methods.
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