Limited Evidence for Use of a Black Race Modifier in eGFR Calculations: A Systematic Review

Area of Science:

• Nephrology
• Clinical Chemistry
• Health Equity

Background:

• Estimated glomerular filtration rate (eGFR) equations often incorporate a Black race modifier (BRM).
• Race is a social construct with inconsistent clinical application, affecting eGFR calculations.
• The BRM elevates eGFR in Black individuals, potentially masking kidney disease.

Purpose of the Study:

• To systematically evaluate literature on eGFR equations with and without the BRM.
• To examine the clinical impact of including or excluding the BRM in eGFR calculations.
• To assess the evidence supporting the use of the BRM in clinical practice.

Main Methods:

• Searched PubMed and Embase for studies comparing measured GFR to eGFR in diverse adult populations.
• Included studies using Modification of Diet in Renal Disease or CKD Epidemiology Collaboration equations.
• Analyzed 96 studies, with 44 selected for final assessment of eGFR equations with and without BRM.

Main Results:

• Limited published evidence supports the use of a BRM in eGFR equations.
• Equations without the BRM may enable earlier detection of chronic kidney disease (CKD).
• Potential for over-diagnosis of CKD or impact on downstream interventions exists when removing the BRM.

Conclusions:

• The evidence base for employing a BRM in eGFR equations is currently weak.
• Further research is needed to understand the full clinical implications of removing the BRM.
• Clinical decisions regarding eGFR calculation should consider the limitations of race-based modifiers.