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Abstract: TH-PO999

Effect of Race-Free Estimated Glomerular Filtration (eGFR) Equation on CKD Prevalence in the US Military Health System (MHS)

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Oliver, James D., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
  • Nee, Robert, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
  • Marneweck, Hava, Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, United States
  • Banaag, Amanda, Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, United States
  • Koyama, Alain K., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Koehlmoos, Tracey L., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
Background

The 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation removed race as a factor in the calculation of eGFR. We assessed the potential impact on CKD prevalence using the MHS Data Repository, a large network health care database covering a diverse population comparable to the US general population.

Methods

We extracted MHS data from 2016-2019 for adults age ≥18. We compared CKD prevalence using eGFR calculated from the 2009 race-adjusted vs. the 2021 race-free CKD-EPI equations. Race was classified as Black or non-Black and was imputed in 23.7% of the population. CKD stages 3-5 was defined as eGFR < 60 mL/min/1.73m2 for ≥90 days. We evaluated addtional population changes at eGFR thresholds (<45, <30, <20 mL/min/1.73m2) important for clinical decision-making.

Results

The study included 1,970,433 adults with median (IQR) age 40 (29–55) yrs, 49.2% female, and 18.0% Black adults. With the 2021 equation, Black adults with CKD increased from 5828 to 8928, a change in crude prevalence from 1.6 to 2.5% (Table). Non-Black adults with CKD declined from 43,126 to 30,932, a crude prevalence change from 2.7 to 1.9%. The Black adult population with eGFR <60, <45, <30, and <20 mL/min/1.73m2 increased by 53.2%, 29.0%, 18.6%, and 28.7%, respectively while that for non-Black adults declined by −28.3%, −26.6%, −26.0%, and −27.8%, respectively. Cumulatively, 44.4% of Black adults with CKD and 42.1% of non-Black adults with CKD were reclassified across eGFR strata.

Conclusion

The new eGFR equation in the MHS will reclassify many Black adults to new or more advanced CKD stages, with the opposite effect on non-Black adults. The impact on time to diagnosis, clinical management, and outcomes is unknown but there may be shifts in referral patterns to nephrology, dialysis, and transplant services. Ongoing surveillance of CKD is warranted.

The views expressed in this abstract are those of the authors and do not reflect the official position of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense, the Department of Health and Human Services, or the US Government.

Funding

  • Other U.S. Government Support