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Ethn Dis. 2016 Apr 21;26(2):213-20. doi: 10.18865/ed.26.2.213.

Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults.

Author information

1
Department of Medicine, University of California, San Francisco; San Francisco, Veterans Affairs Medical Center.
2
Department of Medicine, University of California, San Francisco.

Abstract

OBJECTIVE:

The aim of our study was to investigate whether current eGFR equations in clinical use might systematically over-estimate the kidney function, and thus misclassify CKD status, of Black Americans with HIV. Specifically, we evaluated the impact of removing the race coefficient from the MDRD and CKD-EPI equations on comparisons between Black and White HIV-infected veterans related to: 1) the prevalence of reduced eGFR; 2) the distribution of eGFR values; and 3) the relationship between eGFR and all-cause mortality.

DESIGN:

Retrospective cohort study.

SETTING:

The Department of Veterans Affairs (VA) HIV Clinical Case Registry (CCR), which actively monitors all HIV-infected persons receiving care in the VA nationally.

PATIENT/PARTICIPANTS:

21,905 treatment-naïve HIV-infected veterans.

MAIN OUTCOME MEASURES:

Estimated glomerular filtration rate (eGFR) using the abbreviated Modification of Diet in Renal Disease (MDRD) formula with and without (MDRD-RCR) the race coefficient and all-cause mortality.

RESULTS:

Persons with eGFR <45 mL/min/1.73m(2) had a higher risk of death compared with those with eGFR >80 mL/min/1.73m(2) among both Blacks (HR=2.8, 95%CI: 2.4-3.3) and Whites (HR=1.9, 95%CI: 1.4-2.6), but the association appeared to be stronger in Blacks (P=.038, test for interaction). Blacks with eGFR 45-60 mL/min/1.73m(2) also had a higher risk of death (HR=1.7, 95%CI: 1.4-2.1) but Whites did not (HR=.86, 95%CI: .67-1.10; test for interaction: P<.0001). Racial differences were substantially attenuated when eGFR was re-calculated without the race coefficient.

CONCLUSIONS:

Our findings suggest that clinicians may want to consider estimating glomerular filtration rate without the race coefficient in Blacks with HIV.

KEYWORDS:

Chronic Kidney Disease; Estimated Glomerular Filtration Rate; Human Immunodeficiency Virus; Mortality; Racial Disparities

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