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.).

Summary

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.

Related Concept Videos

Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration

Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area.
30
Chronic Kidney Disease I: Introduction01:25

Chronic Kidney Disease I: Introduction

Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
202
Factors Affecting Renal Clearance: Renal Impairment01:17

Factors Affecting Renal Clearance: Renal Impairment

Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
204
Chronic Kidney Disease III: Interprofessional Care01:28

Chronic Kidney Disease III: Interprofessional Care

Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
136
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
89
Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
23