How does diabetes increase the risk of kidney disease? When the MDRD equation was developed in 1999, it used race as a modifier to help better predict GFR in Black individuals. Keep reading as we break down the use of race in determining eGFR, its impact, and how this is changing. 2013;13(6):610-613. doi:10.7861/clinmedicine.13-6-610. However, a recent study suggested that race is, as in the case of eGFR, likely a convenient substitute for some other poorly characterized negative prognostic factor. (2021). However, they could also represent false positives. You may be able to receive a kidney transplant. With proper management, you may never need dialysis or, at least, not for a very long time. People with CKD often take medicines to lower blood pressure, control blood sugar, and lower blood cholesterol. The lab report shows two eGFR calculations, one estimate for Black/African Americans and another for non-Black/African Americans. Starting on May 4, 2021, UC Davis Health will calculate estimated glomerular filtration (eGFR) rate without a parameter for race. An NKF and ASN task force has recently released a final recommendation for a way to determine eGFR thats not based on race. Removing race from eGFR determination isnt without potential drawbacks, however. All rights reserved. Stage 1 GFR of 90+ A GFR of 90 or higher is normal in most healthy people. In September 2021, the NKF-ASN Task Force announced recommendations to remove Black race in the eGFR calculation. Its also possible for GFR to be very high in some people. Because testing GFR can be very complex, its often estimated. This is particularly important if youre at an increased risk of kidney disease, especially if you have diabetes. Weis L, et al. The eGFR calculation accounts for biological factors like age, sex, and body weight. This implies that the use of eGFR alone as a screening tool may not be sensitive enough to find CKD in this population. The symptoms may not be noticeable until the condition is advanced. Each category is based on whats causing the ARF to occur. (n.d.). In fact, the race coefficient in the MDRD and CKD-EPI equations is presumably correcting for some other poorly characterized factor which raised the baseline serum creatinine levels in the persons in the training population for these two equations. An eGFR score of under 15 may indicate kidney failure. eGFR 30-59, moderate kidney damage. SCr)-1.154x (age)-0.203x (0.742 if female) x (1.210 if African American) Diabetic nephropathy. Stage 1: eFGR 90; kidneys work as well as normal Stage 2: eGFR 60-89; mild kidney damage Glomeruli are complex structures made of tiny blood vessels called. The lower the value, the less efficiently your kidneys are working. It is unclear what the clinical consequences would be of reassigning these patients to the higher risk group by calculation with the NAA equation. In the case of acute kidney injury (AKI), it is worth considering that part of the definition of AKI involves a significant change in serum creatinine from the patients baseline. Currently, the test considers your age, sex, and race, among other factors. Please use the NIDDK-funded CKiD U25 eGFR calculator, 2 an interactive app developed by the hCode team, to calculate eGFR for children and young adults ages 1 to 25. Understanding African American and non-African American eGFR laboratory results. As more damage occurs, the kidneys are unable to keep the body healthy - then dialysis or a kidney transplant may be needed to maintain health. An eGFR score of 60 or higher indicates normal functioning. What does my eGFR mean? Several studies suggest that the equations used to calculate eGFR may overestimate GFR in black Americans, potentially leading to underdiagnosis of CKD. The NKF and ASN are urging all laboratories and healthcare systems across the country to adopt this new measure as soon as possible. Eneanya ND, et al. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2018. A normal eGFR is 60 or more. Youre not likely to notice other symptoms in the early stages of kidney disease, so getting tested is important if youre at an increased risk. However, updated equations now exclude race and ethnicity when calculating eGFR. The blood sample is then sent to a laboratory for testing. If you arent sure, its best to ask your doctor. Learn more here, A recent study finds that people with gout have a higher risk of advanced chronic kidney disease. An eGFR score of 60 or higher indicates normal functioning. In later stages, the symptoms of kidney disease can include: A GFR of 15 or lower is a sign of kidney failure. Comparison of equations for estimating glomerular filtration rate in screening for chronic kidney disease in asymptomatic black Africans: A cross sectional study. BMC Nephrology 2017;18(1): 369. Retrieved from https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/kidney-disease/laboratory-evaluation/glomerular-filtration-rate/estimating. In the United States, a different version of the formula is generally used when calculating eGFR test results for Black people. Reassessing the inclusion of race in diagnosing kidney diseases: An interim report from the NKF-ASN task force. It may be estimated from your blood level of creatinine. The coefficient for this equation is slightly lower than the one used for the MDRD equation. What is a normal eGFR number? See if you can qualify for a transplant. Its possible that your doctor will ask you to fast for a specific period of time before your blood test, especially if youre having additional tests that require fasting. convincingly suggest that polymorphisms in apolipoprotein L1 (APOL1) may in part account for poorer outcomes in some allografts from African-American donors.19, Chronic renal disease frequently co-occurs with cardiac disease, and eGFR is a prognostic indicator and clinical predictor in patients with heart failure.20 Furthermore, measures of eGFR may influence the dosing and choice of medical therapy, as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs) can cause increases in serum creatinine.21 However, patients are at risk of undertreatment if these medications are withheld due to small decreases in eGFR.22. This step is usually completed by a technician at the testing lab or by your doctor. 2020;20(2):146-150. doi:10.7861/clinmed.2019-0422. A GFR of 15 or lower may mean kidney failure. However, more recent research from 2008 found that high creatinine levels in Black individuals are likely due to factors besides muscle mass and nutrition status, as originally thought. Approximately 1 month of serum creatinine values and corresponding eGFR data was obtained from Beaker, along with each patients age and sex, from 373 patients over age 18 who provided 497 specimens (range: 1-10 specimens per patient). The NKF states that African American people should be aware of their increased kidney disease risk and its risk factors, which include high blood pressure, diabetes, and heart disease. These cases, as noted above, could represent cases of CKD that would be missed if the AA equation was utilized to calculate eGFR. The authors also point out several flaws in the clinical categorization of race, including the nature of race as a social construct that does not correlate well to underlying genotypic or metabolic differences among persons. Healthline Media does not provide medical advice, diagnosis, or treatment. It is worth noting that the largest number of patients reassigned to a lower risk group by the AA equation were those with eGFRs between 60-90 mL/min as calculated by the NAA equation. An eGFR score of under 15 may indicate kidney failure. Examining the potential impact of race multiplier utilization in estimated glomerular filtration rate calculation on African-American care outcomes. The National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) formed a joint task force in 2020 to review the use of race and ethnicity in these calculations. This was based on research studies which found that people who identified as Black or African American can have higher levels of creatinine in their blood. The results of an eGFR calculation tell your doctor about the stage of your kidney disease. Treating kidney disease may also help prevent heart disease. Normal filtration in young adults is . What is a glomerular filtration rate (GFR) test? (2021). Anker N, Scherzer R, Peralta C et al. (2013). This supports the goal of narrowing some of the disparities in CKD, including the higher prevalence of CKD in African Americans compared to white patients, the higher rate of progression to ESRD, and transplant eligibility. PMID 32188648. This can result in a missed or late diagnosis of kidney disease. Tonneijck L, et al. Jones CA, et al. Including race in eGFR calculations has caused much debate. Varghese RT, et al. Advantages and disadvantages of participating in clinical trials. We cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this website. If your eGFR is less than 90 for three months or more, your kidneys may not be working well. Using race to help calculate eGFR can have harmful consequences. Doctors may conduct several tests to check on health and disease progression in people with CKD. Many kidney doctors have published that your function for Creatinine could easily be in the 1.7 to 1.9 range (and thus your GFR Not within normal ranges), if one kidney is removed. A task force led by the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) was formed in 2020 to look into the use of race in the GFR test. Moderately decreased GFR: 30-59 mL/Min. (2009). However, a GFR of 60 or higher is also considered within the normal range if you do not have other signs of kidney disease. In some people with glomerular hyperfiltration, GFR can go as high as 180. GFR stands for glomerular filtration rate. Stage 1 GFR 90 or above = Normal or near-normal kidney function Stage 2 GFR 60 to 89 = Mild loss of kidney function Stage 3a GFR 45 to 59 = Mild to moderate loss of kidney function Stage 3b GFR 30 to 44 = Moderate to severe loss of kidney function Stage 4 GFR 15 to 29 = Severe loss of kidney function Stage 5 GFR Less than 15 = Kidney failure These conditions can hurt your kidneys. African American people also make up over 35% of people in the U.S. who receive dialysis for kidney failure. Last medically reviewed on October 22, 2021. The Centers for Disease Control and Prevention (CDC) estimate that more than 1 in 7 adults in the United States have CKD. Negative agreement was 91.2% for males and 93.4% for females, meaning that overall only a relatively small number of patients were reassigned to CKD positive status. Madhusoodanan J. The change to a single eGFR value calculated by CKD-EPI without a parameter for race is intended to increase the sensitivity of the eGFR calculation for chronic kidney disease. Diabetic kidney disease. To summarize, many of the patients in this group with borderline eGFRs have significant risk factors for CKD and at the least warrant close follow-up. As such, measures that are more clearly understood would serve as better indicators of kidney function. This includes: Additionally, you can find more information about kidney disease by checking out the websites for the National Kidney Foundation or the American Kidney Fund. Acknowledging variability in creatinine-based calculations of eGFR will give the clinician the flexibility for shared decision making in initiating therapy in these patients, recommendation for transplant waiting lists, and ensuring clinical trial eligibility based on the patients overall clinical status instead of a single number. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD). If your eGFR is less than 60 for three months or more, your kidneys may not be working well. Treatment includes keeping blood pressure at the level set by your provider, eating foods with less salt and the right amount of protein, and controlling blood sugar if you have diabetes. Further, clinicians may improperly assign race based on arbitrary phenotypic factors such as skin tone or hair.12 On the laboratory side, the problems of uncertainty in this arbitrary categorization are acknowledged in the way eGFR is currently reported, with values with and without the race coefficient simultaneously reported, leaving it for the clinicians to decide how to interpret eGFR in their patients case.13, Equations based on the measurement of serum levels of cystatin C have been developed and are being analyzed in various populations; for the purpose of comparability, there now exists a reference standard for cystatin C.14 The CKD-EPIcys equation mentioned earlier was developed in 2012. A normal eGFR is 90 or higher, as long as you don't have any other signs of kidney damage. eGFR is a key test used to diagnose kidney disease and understand how your kidneys are working. A missed or late diagnosis is potentially dangerous, as kidney disease disproportionately affects Black people. To do this, they take a blood sample to measure the amount of creatinine in the blood and use an equation to calculate eGFR. Your eGFR is an estimated number based on a blood test and your age, sex, body type and race. Some examples include the University of Washington Medical Center and the University of Vanderbilt Medical Center. By taking steps to manage your diabetes and live a health-promoting lifestyle, you can reduce your risk. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2018. The new eGFR 2021 CKD EPI creatinine equation estimates kidney function without race as a factor. Reporting Glomerular Filtration Rate. (n.d.). Levey A, Bosch J, Lewis J et al. By itself, high blood pressure is also a risk factor for kidney disease, as it can damage your kidneys. Over of patients receiving kidney dialysis in this country are African American. Estimating glomerular filtration rate. In 2009, the development of the CKD-EPI equation also used race as a modifier. We invite you to learn more about our social media guidelines, which apply to all UC Davis Health social media channels, including blogs. 2017;17(6):1540-1548. doi:10.1111/ajt.14113. MDRD equation GFR = 186 x (Stand. Patient advocate Curtis Warfield describes his care journey with chronic kidney disease (CKD) from diagnosis to transplant. For values below 60 mL/min/1.73 m 2, the report should give the numerical estimate rounded to a whole number (e.g., "32 mL/min/1.73 m 2 "). The US Renal Data System (USRDS) 2018 Annual Report showed that black Americans in older age groups experienced higher rates of CKD compared to white Americans of similar age.1 This finding is also shared by the Jackson Heart Study, an epidemiologic study of black Americans in Mississippi, with the rate of CKD in this population close to 20%.2 Black Americans have a marked increased risk for end-stage renal disease (ESRD), with an age-sex-standardized incidence ratio of 2.9 compared to white Americans in 2016.3 Also troubling, black patients with ESRD exhibit a lower rate of kidney transplant compared to persons of other races.4 It is in this context that we need to reevaluate measures of kidney function that are estimated differently based on self-reported African American race.