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


METHODS
Retrospective cohort study.


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


METHODS
21,905 treatment-naïve HIV-infected veterans.


METHODS
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.
Department of Medicine, University of California, San Francisco; San Francisco, Veterans Affairs Medical Center.
Naomi
N
Anker
Department of Medicine, University of California, San Francisco.
Rebecca
R
Scherzer
Department of Medicine, University of California, San Francisco.
Carmen
C
Peralta
Department of Medicine, University of California, San Francisco.
Neil
N
Powe
Department of Medicine, University of California, San Francisco.
Tanushree
T
Banjeree
Department of Medicine, University of California, San Francisco; San Francisco, Veterans Affairs Medical Center.
Michael
M
Shlipak
D000328:Adult; D000368:Aged; D003404:Creatinine / Q000378:metabolism*; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications / Q000208:ethnology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D014728:Veterans; D044465:White People
D003404:Creatinine
Chronic Kidney Disease; Estimated Glomerular Filtration Rate; Human Immunodeficiency Virus; Mortality; Racial Disparities