Estimated GFR and race

The estimated glomerular filtration rate (eGFR)includes a correction factor for black patients.

Some suggest that this correction factor has racial bias and should be abolished.

Measured GFR for Black Americans is, on average, 15.9% higher than that for non-Black persons with the same creatinine level, sex, and age.

Observed differences of increased GFR in blacks includes tubular secretion and creatinine generation, while differences in body size or muscle mass do not explain the


Nearly all laboratories estimate GFR by using race, but recently many have removed the race coefficient for black patients over concern about differential access to kidney transportation and specialist care.

Reasons for observed differences in serum creatinine among black study participants has never been elucidated.

The current guideline uses eGFRcr as the initial test in GFR evaluation, with an equation that includes race (Black versus non-Black), because studies indicate a higher average serum creatinine level for the same measure GFR level in black participants than  in non-black participants.

Blacks have a 3 to 4 full greater risk of kidney failure and higher mortality compared with individuals of other races and ethnicities with approximately 16% to 21% better estimated glomerular filtration rate compared with other individuals.

Using equations that incorporate creatinine and cystatin C but omit race a more accurate and led to smaller differences between black participants and non-black participants than equations without race with either creatinine or cystatin C alone.

The benefits of this reclassification include: more black patients will be eligible for nephrology special care and kidney transplants.

This classification change however may include more black patients being ineligible for certain medical treatment such as metformin.

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