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Kidney and liver living donor

Monday September 12, 2022 - 17:35 to 18:35

Room: CF-5

244.4 Performance of Updated Estimated Glomerular Filtration Rate Equations in Black Living Kidney Donor Candidates

Joshua Augustine, United States

Associate Professor of Medicine
Nephrology and Hypertension
Cleveland Clinic


Performance of updated estimated glomerular filtration rate equations in black living kidney donor candidates

Joshua Augustine1, Aimen Liaqat1, Susana Arrigain2, Jesse D Schold2, Emilio D Poggio1.

1Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH, United States; 2Center for Populations Health Research, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States

Purpose: New estimated glomerular filtration rate (eGFR) equations using serum creatinine (Cr) and/or cystatin C (CysC) have been derived to eliminate adjustment by perceived Black ancestry.  We sought to analyze the performance of newer eGFR equations in Black living kidney donor (LD) candidates.

Methods: Black LD candidates (n=64) who had measured iothalamate (i)GFR  between 1/2015 and 10/2021 were included, and eGFR was calculated using race adjusted (Cr2009, Cr-CysC2012) and race unadjusted (Cr2021, Cr-CysC2021) CKD-EPI equations.  Bias (eGFR-iGFR) and accuracy (percent within 30% of iGFR) were calculated.

Results: Mean age at LD evaluation was 41±12 yrs, and 45% were male.  Mean iGFR was 105±23 ml/min/1.73m2.  Results are shown in Table 1.

CKD-EPICr2021 eGFR showed a greater negative bias, and underestimated iGFR to a level < 80 ml/min/1.73m2 in 11% with iGFR ≥ 80.  Alternatively, the CKD-EPICr-CysC2021 equation showed less bias and high accuracy in the absence of correction for Black ancestry.  In donor candidates with iGFR ≥ 80 ml/min/1.73m2, none were estimated below 80 by the CKD-EPICr-CysC2021 equation. Eighteen Black candidates went on to donate and had eGFR measured at 6-18 months post-donation.  By the Cr2021 equation, substantially more donors had an eGFR < 60 ml/min/1.73m2 (44%), Table 2.

Conclusions: The CKD-EPICr2021 equation appears to underestimate true GFR in Black LD candidates, with the potential to exclude some for falsely low eGFR, and the potential to underestimate GFR post-donation.  Alternatively, the recently recalibrated CKD-EPICr-CysC2021 equation appears to perform well in Black LD candidates, without negative bias or underestimation.

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