Kidney Week

Abstract: SU-OR41

Differences in Kidney Failure Risk by Race/Ethnicity at the Time of GFR-Based Transplant Eligibility

Session Information

• Challenges in Clinical Transplantation
  October 25, 2020 | Location: Simulive
  Abstract Time: 05:00 PM - 07:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Chu, Chi D., University of California San Francisco, San Francisco, California, United States

Chi D. Chu, MD



Chi D. Chu, MD, MAS is a nephrology research fellow at the University of California, San Francisco. As part of his fellowship at UCSF, he completed a Master's degree in clinical research. His research centers on the quality of chronic kidney disease care across the spectrum from early detection and awareness to implementation of evidence-based therapies, with a particular interest in how clinical risk prediction could be applied to advance effective and equitable care delivery.

• Powe, Neil R., University of California San Francisco, San Francisco, California, United States

Neil R. Powe,

• Tuot, Delphine S., University of California San Francisco, San Francisco, California, United States

Delphine S. Tuot,

Background

Glomerular filtration rate (GFR) less than 20 ml/min/m² is a criterion for kidney transplant listing, but variation in underlying end-stage kidney disease (ESKD) risk distributions by race/ethnicity has the potential to produce systematic racial disparities due to under recognition of the higher progression risk when a singular eGFR threshold is used as a decision point.

Methods

We compared predicted kidney failure risk by race/ethnicity for patients at the time their eGFR fell below 20 ml/min/m² using the OptumLabs® Data Warehouse (OLDW), a longitudinal, real-world data asset with de-identified administrative claims and electronic health record (EHR) data. We identified patients 18-70 years old from 1/1/2014-6/30/2019 who had at least one eGFR >20 ml/min/m², and at least two later eGFR values ≤20 ml/min/m² that were ≥90 days separated, who also had a urine albumin/creatinine ratio (UACR) measured within 90 days of the first eGFR ≤20 ml/min/m². We calculated 2-year risk of ESKD for each patient using the 4-variable Kidney Failure Risk Equation and compared the distributions by race/ethnicity.

Results

Of 2926 patients, 2024 were non-Hispanic white (NHW), 649 non-Hispanic black (NHB), and 253 Hispanic. At the time of incident eGFR ≤20 ml/min/m², NHWs were older than NHB or Hispanic patients (mean age 59.2 versus 56.2 or 54.3 years, respectively) and had lower median UACR (0.67 versus 1.36 or 1.72 g/g, respectively). Compared to ESKD risk among NHWs (median predicted risk 38.7%), the risk distribution was skewed toward higher risk for NHB and Hispanic patients, who had median predicted risks of 49.4% and 55.8% respectively (Figure).

Conclusion

At the time of incident eGFR ≤20 ml/min/m², NHB and Hispanic populations had greater risk of ESKD. A racial/ethnic disparity in time from GFR-based transplant eligibility to ESKD may exist even with elimination of disparities in timing of transplant referral and waitlisting. Consideration of kidney failure risk might be given greater attention in access to transplantation.

Funding

• NIDDK Support