Related Experiment Video
Updated: Jun 18, 2025
A High-throughput Method for Measurement of Glomerular Filtration Rate in Conscious Mice
Published on: May 10, 2013
Impact of Race-Free Glomerular Filtration Rate Estimations on CKD Prevalence in the US Military Health System: A
James D Oliver1, Robert Nee1,2, Hava Marneweck3,4
1Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
Rationale & Objective:
The 2021 CKD-EPI removes Black race as a factor in calculating the estimated glomerular filtration rate (eGFR). We assessed its effect on CKD prevalence in the demographically-diverse US Military Health System.
Study Design:
A retrospective calculation of the eGFR from serum creatinine measured over 2016-2019 using both the 2009 and 2021 CKD-EPI equations.
Setting & Population:
Multicenter health care network with data from 1,502,607 adults in the complete case analysis and from 1,970,433 adults in an imputed race analysis.
Predictors:
Serum creatinine, age, sex, and race.
Outcome:
CKD stages 3-5, defined as the last eGFR persistently < 60 mL/min/1.73m2 for ≥90 days.
Analytical Approach:
The t test and Kruskal-Wallis test were used for continuous variables and Χ2 for categorical data.
Results:
The population in the complete case analysis had a median age of 40 years and was 18.8% Black race and 35.4% female. With the 2021 equation, the number of Black adults with CKD stages 3-5 increased by 58.1% from 4,147 to 6,556, a change in the crude prevalence from 1.47% to 2.32%. The number of non-Black adults with CKD stages 3-5 decreased by 30.4% from 27,596 to 19,213, a crude prevalence change from 2.26% to 1.58%. Similar results were seen with race imputation. Cumulatively, among adults with CKD stages 3-5 by at least one equation, 45.8% of Black adults were reclassified to more advanced stages of CKD and 44.0% of non-Black adults were reclassified to less severe stages across eGFR thresholds that could change clinical management.
Limitations:
Potential underestimation of CKD in individuals with only 1 measurement.
Conclusions:
Adoption of the 2021 CKD-EPI equation in the Military Health System reclassifies many Black adults into new CKD stages 3-5 or into more advanced CKD stages, with the opposite effect on non-Black adults. This may have an effect on CKD treatment and outcomes in ways that are yet unknown.
Related Concept Videos
01:17Factors Affecting Renal Clearance: Renal Impairment
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...
01:02Renal Drug Excretion: Glomerular Filtration
Drugs gain access to the kidney via the renal artery, which progressively branches off into afferent arterioles....
01:23Renal Clearance
Renal clearance refers to the volume of plasma cleared of a specific substance, such as creatinine, per unit of time. To measure clearance, urine samples are collected over a 24-hour period during each bladder voiding, followed by a single blood sample at the...
01:28Glomerular Filtration Rate and its Regulation
GFR regulation involves two primary intrinsic controls: the myogenic and tubuloglomerular feedback mechanisms.
The myogenic...
01:07Determination of Renal Drug Clearance: Graphical and Midpoint Methods
The graphical method involves plotting the rate of drug excretion in urine against the plasma drug concentration. By analyzing the graph, the clearance can be calculated and obtained. Drugs rapidly excreted by the kidneys exhibit a...
01:26Glomerular Filtration: Net Filtration Pressure
GBHP, with an average value of 55 mmHg, promotes filtration by pushing water and solutes through the filtration membrane. This is balanced by two opposing forces: CHP, a "back pressure" exerted against the filtration membrane by fluid already in the capsular space and renal...