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Glomerular Filtration Rates (GFR) Reference Values for Living Kidney Donors Using the 2021 CKD-EPI Equation without the Race Factor

A. Liaqat, L. Cholin, H. Sawaf, S. Arrigain, J. Augustine, J. Schold, E. Poggio

Cleveland Clinic, Cleveland, OH

Meeting: 2022 American Transplant Congress

Abstract number: 1717

Keywords: Glomerular filtration rate (GFR), Kidney transplantation, Living donor, Screening

Topic: Clinical Science » Kidney » 42 - Kidney Living Donor: Selection

Session Information

Session Name: Kidney Living Donor: Selection

Session Type: Poster Abstract

Date: Tuesday, June 7, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Kidney function is central to donor evaluation and KDIGO guidelines recommend using estimated GFR (eGFR) for initial screening. A new creatinine-based CKD-EPI equation (’21 eGFR eq) without race is being incorporated in clinical practice, and therefore having GFR reference values based on age, gender and race for screening prospective living kidney donors is of clinical importance.

*Methods: We compared cold iothalamate GFR (iGFR) to eGFR derived from the ’21 eGFR eq which excludes the race factor and the 2009 CKD-EPI eq (’09 eGFR) in donors stratified by age, gender and race. We report the lowest 5th percentile (P5) and the median (P50) GFR for each method to determine minimum accepted GFR for donation by donor’s age, gender and race. We also used an arbitrary cutoff of 80 ml/min/1.73m2 to evaluate percent of black (AA) and non-AA donors below this cutoff.

*Results: We studied 832 donors at our institution b/w 2002 and 2021 with a median age of 44 yrs (IQR 35-52), 61% were female and 9.1% were AA. The median iGFR, ’09 eGFR, ’21 eGFR for all donors was 101 (IQR 92-112), 97 (86-107) and 100 (89-109) ml/min/1.73 m2, respectively (Table 1). Overall, GFR decreases with older age independent of GFR method and is similar by gender. In contrast , the eGFR for AA and non-AA donors differs b/w the ’09 eGFR and ’21 eGFR (Table 2). Only 3.3% non-AA donors had an iGFR of <80 ml/min/1.73m2, but 14.4% of non-AA donors were below this cutoff and 2.6% AA donors using the race-based equation ’09 eGFR. The new ‘21 eGFR eliminates this difference by equalizing the eGFRs between AA and non-AAs. With the new eq 9.9% of all donors would fall below a pre-determined screening cut off GFR value for further evaluation (9.8% of non-AA and 10.5% of AA donors). The P5 for AA donors decreased from 83 to 75 ml/min/1.73m2 when using ’09 eGFR compared to the ’21 eGFR eq which makes it similar to the p5 of non-AA.

*Conclusions: Using the CKD-EPI 2021 equation, screening eGFR values should be adjusted for donor’s age but not gender or race. However, while the new equation eliminates the difference in eGFR b/w AA and non-AA, it overall underestimates iGFR thus screening values should be adjusted in order not to miss any potential donor with optimal measured GFR.

GFR by Age Gender and Race
Group N=832 P5 iGFR P50 iGFR P5 2009 CKD-EPI P50 2009 CKD-EPI P5 2021 CKD-EPI P50 2021 CKD-EPI
Age 18-35 232 87 106 83.3 110.1 85 110.7
Age 36-45 241 86 103 77.4 98.3 77.9 99.1
Age >45 359 79 96 69.4 90.3 72.9 93.9
Male 325 83 100 72.7 95.5 76.4 98.8
Female 507 81 103 72 97.3 74.9 100.1
Non-AA 756 81 101 72.2 95.8 75.8 99.8
AA 76 85 105 82.9 108.6 74.7 97
GFR <80 for AA versus non-AA, N (column %)
Factor N=832 Non-AA (N=756) AA (N=76) p-value
iGFR <80 ml/min/1.73m2 25 (3%) 25 (3.3%) 0 (0%) 0.16d
2009CKD EPI <80 ml/min/1.73m2 111 (13.3%) 104 (14.4%) 2 (2.6%) 0.004c
2021 CKD EPI 2021 <80 ml/min/1.73m2 82 (9.9%) 74 (9.8%) 8 (10.5%) 0.84c
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To cite this abstract in AMA style:

Liaqat A, Cholin L, Sawaf H, Arrigain S, Augustine J, Schold J, Poggio E. Glomerular Filtration Rates (GFR) Reference Values for Living Kidney Donors Using the 2021 CKD-EPI Equation without the Race Factor [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/glomerular-filtration-rates-gfr-reference-values-for-living-kidney-donors-using-the-2021-ckd-epi-equation-without-the-race-factor/. Accessed May 8, 2025.

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