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Challenges for eGFR equations in the developing world
Gershwin Davis1, Srikanth Umakanthan1, Lexley Pinto Pereira1
1Department of Paraclinical Sciences, The University of the West Indies St Augustine Campus, St. Augustine, Trinidad and Tobago.
Current Medical Research and Opinion
|October 2, 2024
Summary
New CKD-EPI 2021 equations for estimating glomerular filtration rate (GFR) in diverse populations highlight non-biological factors. Social determinants and cultural context significantly impact chronic kidney disease (CKD) patient care and outcomes.
Area of Science:
- Nephrology
- Public Health
- Health Disparities
Background:
- Low and middle-income countries harbor the highest burden of chronic kidney disease (CKD), characterized by ethnic diversity.
- Effective management of CKD necessitates accurate estimation of glomerular filtration rate (GFR) using equations tailored to local populations.
- CKD is associated with conditions like diabetes and hypertension in adults, and urinary tract issues in the young.
Purpose of the Study:
- To examine the implications of the CKD-EPI 2021 equations, which exclude race, for adult and young adult populations.
- To highlight the importance of considering non-biological factors in renal care, particularly in diverse, resource-limited settings.
- To underscore the influence of social determinants of health on CKD management and patient outcomes.
Main Methods:
- Review and discussion of the CKD-EPI 2021 equations and their impact on GFR estimation.
- Analysis of how non-biological factors, including social determinants and cultural context, influence renal patient care.
- Comparative assessment of the impact of non-biological factors versus racial disparity on renal care outcomes.
Main Results:
- The CKD-EPI 2021 equations shift focus from race to the relevance of cultural and economic contexts in managing renal patients.
- Social determinants of health, gender identity, cultural acceptance, test selection, communication, and technology can significantly affect renal care.
- These non-biological factors may exert a greater influence on renal patient care and outcomes than historical racial disparities.
Conclusions:
- The CKD-EPI 2021 equations necessitate a broader consideration of factors beyond biology in assessing GFR and managing CKD.
- Addressing social determinants of health and cultural contexts is crucial for improving renal care, especially in ethnically diverse, low- and middle-income countries.
- Future strategies for CKD management must integrate socio-cultural considerations to enhance patient outcomes effectively.
