The latest JASN features a very important submission, by a distinguished authorial roster, concerning the altered clinical use and outcomes once race-independent GFR values are used instead of those derived from Chronic Kidney Disease Epidemiology Collaboration and even more antique formulas.1
This excellent review,1 which signposts important possibly life-altering changes in the way that GFR will be applied to patients of all races, carries a serious and troubling statement, namely “A national task force convened by the NKF-ASN2 recently recommended a new race-free creatinine equation for calculating eGFR…its broad effect on recommended clinical care across the eGFR spectrum and across different racial and ethnic groups is not known.” That statement is remarkable as presented, as surely thorough modeling of the clinical impact of such a fundamental change must have been undertaken before, and not after, these changes were adopted. In the event, the new analysis1 suggests that nationwide implementation of the new eGFR equation may affect recommended care for 100,000s of Black adults and 1,000,000s of non-Black adults, including altered CKD diagnoses; CKD stage reclassifications; and changes in kidney donation eligibility, nephrologist referral, and medication dosing. These are dramatic alterations for a sizable number of patients, as presaged by others.3,4
How confident are the authors that medication dosing will potentially be altered for drugs which include but are not limited to beta-blockers, Sodium-Glucose Cotransporter-2 inhibitor, statins, antibiotics, etc? For such medications to be effective at preventing CKD progression and cardiovascular disease, and to reduce the risk of toxicity, it is surely incumbent to use them based on consistent and patient-specific GFR measurements? Is it also correct to encourage medication changes to be made to individual patients in large sections of the population based solely on the use of the imprecise population-derived eGFR formulas currently available to clinicians?
Disclosures
None.
Funding
None.
Footnotes
(Retired Nephrologist), United Kingdom.
See original article, “National Projections for Clinical Implications of Race-Free Creatinine-Based GFR Estimating Equations,” in Vol. 34, Iss. 2, 309–321 and related article, “Author reply: GFR, Race, and Implications,” on pages 721–722.
References
- 1.Diao JA, Wu GJ, Wang JK, et al. National projections for clinical implications of race-free creatinine-based GFR estimating equations. J Am Soc Nephrol. 2023;34(2):309-321. doi: 10.1681/ASN.2022070818 [DOI] [PMC free article] [PubMed] [Google Scholar]
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