Session Date & Time: None. Available on demand.
*Purpose: GFR < 20 is required for kidney transplant listing. The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) equations for estimating GFR incorporate serum creatinine, age, sex and a correction factor for Black race. The aim of this study was to investigate whether eGFR equations contribute to disparities in preemptive listing of black patients.
*Methods: We identified all patients added to our kidney transplant waiting list since 2008. GFR at the time of listing was obtained for patients listed preemptively. MDRD equation was used to calculate eGFR until February 2015 then CKD-EPI. GFR for non-Black patients was modified using the Black race correction factor (1.212 for MDRD, 1.159 for CKD-EPI). The number of patients listed before and after modification was compared in every race/ethnic group.
*Results: Among 410 patients on the waiting list, 166 (41%) patients were preemptively listed. Black patients made up 36% of the waitlist of whom 29% were preemptively listed. White patients made up 24% of the waitlist of whom 62% were preemptively listed (Table 1).After eGFR modification, a total of 35 patients had an eGFR >20 ml/min and would not qualify for preemptive listing. All non-Black races saw a decrease in preemptive listing.After adjusting for age and gender, White patients had a 4-fold increase in odds of preemptive listing, compared to Black (p<0.001). There was a trend towards increased odds of preemptive listing for Asians compared to Black (OR 1.65, p value 0.068). After modification of GFR the OR between White race and preemptive listing decreased to 2.9 (p<0.001), and the trend towards higher preemptive listing in Asians disappeared.
*Conclusions: Our observations suggest the magnitude of racial disparity in preemptive listing would be reduced if race-based calculation of eGFR was removed.
|Total Waitlist n=410||Listed Preemptive n=166||Listed Preemptive after eGFR modification n=131|
|Race||n (%)||n (%)||Odds Ratio||p-value||n (%)||Odds Ratio||p-value|
|Black||147 (36)||42 (29)||ref||42 (29)||ref|
|62 (62)||4.08||<0.001||44 (54)||2.89||<0.001|
|Asian||98 (24)||39 (39)||1.65||0.07||29 (33)||1.22||0.49|
|Hispanic||65 (16)||23 (35)||1.37||0.32||16 (27)||2.89||0.93|
To cite this abstract in AMA style:Al-Salmay Y, Jandovitz N, Abate M, Baez A, Molmenti E, Fahmy A, Breslin N, Teperman L, Nair V. Removal of Race Factor in Egfr Decreases Disparities in Preemptive Listing for Kidney Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/removal-of-race-factor-in-egfr-decreases-disparities-in-preemptive-listing-for-kidney-transplantation/. Accessed June 20, 2021.
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