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Butler W, Pierre CC, King BE, Young B. Milky Urine in a Patient with Poorly Controlled Type 2 Diabetes. Clin Chem 2024; 70:1099-1102. [PMID: 39222934 DOI: 10.1093/clinchem/hvae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/30/2024] [Indexed: 09/04/2024]
Affiliation(s)
- William Butler
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Christina C Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Health, Lancaster, PA, United States
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Bruce E King
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Health, Lancaster, PA, United States
| | - Brian Young
- Department of Family Medicine, Penn Medicine Lancaster General Health, Lancaster, PA, United States
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2
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Omosule CL, Blair CJ, Herries E, Zaydman MA, Farnsworth C, Ladenson J, Dietzen DJ, Gaut JP. Clinical Utility of LC-MS/MS for Blood Myo-Inositol in Patients with Acute Kidney Injury and Chronic Kidney Disease. Clin Chem 2024; 70:1172-1181. [PMID: 39092926 DOI: 10.1093/clinchem/hvae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/12/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Diagnosing acute kidney injury (AKI) and chronic kidney disease (CKD) relies on creatinine, which lacks optimal diagnostic sensitivity. The kidney-specific proximal tubular enzyme myo-inositol oxygenase (MIOX) catalyzes the conversion of myo-inositol (MI) to D-glucuronic acid. We hypothesized that proximal tubular damage, which occurs in AKI and CKD, will decrease MIOX activity, causing MI accumulation. To explore this, we developed an LC-MS/MS assay to quantify plasma MI and assessed its potential in identifying AKI and CKD patients. METHODS MI was quantified in plasma from 3 patient cohorts [normal kidney function (n = 105), CKD (n = 94), and AKI (n = 54)]. The correlations between MI and creatinine were determined using Deming regression and Pearson correlation and the impact of age, sex, and ethnicity on MI concentrations was assessed. Receiver operating characteristic curve analysis was employed to evaluate MI diagnostic performance. RESULTS In volunteers with normal kidney function, the central 95th percentile range of plasma MI concentrations was 16.6 to 44.2 µM. Age, ethnicity, and sex showed minimal influence on MI. Patients with AKI and CKD exhibited higher median MI concentrations [71.1 (25th percentile: 38.2, 75th percentile: 115.4) and 102.4 (77, 139.5) µM], respectively. MI exhibited excellent sensitivity (98.9%) and specificity (100%) for diagnosing CKD. In patients with AKI, MI increased 32.9 (SD 16.8) h before creatinine. CONCLUSIONS This study unveils MI as a potential renal biomarker, notably elevated in plasma during AKI and CKD. Plasma MI rises 33 h prior to serum creatinine, enabling early AKI detection. Further validation and exploration of MI quantitation in kidney disease diagnosis is warranted.
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Affiliation(s)
- Catherine L Omosule
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Connor J Blair
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Elizabeth Herries
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Mark A Zaydman
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Christopher Farnsworth
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jack Ladenson
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Dennis J Dietzen
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Joseph P Gaut
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Medicine (Nephrology), Washington University School of Medicine, St. Louis, MO, United States
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Turino Miranda K, Dumanski SM, Saad N, Inker LA, White CA, Delanaye P, Collister D, Greene DN, Whitley CT, Harrison TG, Rytz CL, Peace L, Sola DY, Ahmed SB. Glomerular filtration rate estimation in transgender and gender-diverse adults using gender-affirming hormone therapy: an exploratory cross-sectional study. Kidney Int 2024:S0085-2538(24)00544-1. [PMID: 39142563 DOI: 10.1016/j.kint.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/29/2024] [Accepted: 06/14/2024] [Indexed: 08/16/2024]
Affiliation(s)
- Keila Turino Miranda
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Sandra M Dumanski
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Nathalie Saad
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
| | - Christine A White
- Division of Nephrology, Queen's University, Kingston, Ontario, Canada
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium; Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - David Collister
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dina N Greene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Cameron T Whitley
- Department of Sociology, Western Washington University, Bellingham, Washington, USA
| | - Tyrone G Harrison
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Chantal L Rytz
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Darlene Y Sola
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
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4
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Skidmore M, Spencer S, Desborough R, Kent D, Bhandari S. Cystatin C as a Marker of Kidney Function in Children. Biomolecules 2024; 14:938. [PMID: 39199326 PMCID: PMC11352255 DOI: 10.3390/biom14080938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/25/2024] [Accepted: 07/31/2024] [Indexed: 09/01/2024] Open
Abstract
This review examines the reliability of cystatin C as a biomarker for kidney function in paediatric populations. Chronic kidney disease (CKD) affects a significant number of children globally, leading to severe health complications such as anaemia, hypertension, and growth disorders. Traditionally, kidney function has been assessed using the estimated glomerular filtration rate derived from serum creatinine, though this method is flawed due to variability in muscle mass, age, gender, and diet. Cystatin C offers an alternative as it is less influenced by these factors. Evidence from various studies indicates that cystatin C provides a more accurate assessment of kidney function, especially in neonates and children with urinary tract malformations. Additionally, it is more reliable in early detection of acute kidney injury in paediatric intensive care units. Despite its potential, cystatin C is not yet widely adopted in clinical guidelines, primarily due to a lack of large-scale paediatric studies. Nonetheless, existing research supports its utility in providing a consistent and precise measure of kidney function across different paediatric age groups, suggesting that it could enhance early diagnosis and management of CKD in children if more extensive validation studies are conducted.
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Affiliation(s)
- Megan Skidmore
- Faculty of Medicine, Hull York Medical School, Hull HU6 7RU, UK
| | - Sebastian Spencer
- Faculty of Medicine, Hull York Medical School, Hull HU6 7RU, UK
- School of Medical Sciences, University of Hull, Hull HU6 7RX, UK
- Academic Renal Research, Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK
| | - Robert Desborough
- Faculty of Medicine, Hull York Medical School, Hull HU6 7RU, UK
- Academic Renal Research, Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK
| | - David Kent
- Faculty of Medicine, Hull York Medical School, Hull HU6 7RU, UK
- Paediatric Department, Clarendon Wing, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Sunil Bhandari
- Faculty of Medicine, Hull York Medical School, Hull HU6 7RU, UK
- Academic Renal Research, Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK
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5
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Turino Miranda K, Greene DN, Collister D, Krasowski MD, Ahmed SB, Cirrincione LR, Rosas SE, Saad N, Pierre CC. A Holistic Framework for the Evaluation of Kidney Function in a Gender-Diverse Landscape. Am J Kidney Dis 2024; 84:232-240. [PMID: 38458377 DOI: 10.1053/j.ajkd.2024.01.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 03/10/2024]
Abstract
The most commonly used equations to estimate glomerular filtration rate incorporate a binary male-female sex coefficient, which has important implications for the care of transgender, gender-diverse, and nonbinary (TGD) people. Whether "sex assigned at birth" or a binary "gender identity" is most appropriate for the computation of estimated glomerular filtration rate (eGFR) is unknown. Furthermore, the use of gender-affirming hormone therapy (GAHT) for the development of physical changes to align TGD people with their affirmed gender is increasingly common, and may result in changes in serum creatinine and cystatin C, the biomarkers commonly used to estimate glomerular filtration rate. The paucity of current literature evaluating chronic kidney disease (CKD) prevalence and outcomes in TGD individuals on GAHT makes it difficult to assess any effects of GAHT on kidney function. Whether alterations in serum creatinine reflect changes in glomerular filtration rate or simply changes in muscle mass is unknown. Therefore, we propose a holistic framework to evaluate kidney function in TGD people. The framework focuses on kidney disease prevalence, risk factors, sex hormones, eGFR, other kidney function assessment tools, and the mitigation of health inequities in TGD people.
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Affiliation(s)
- Keila Turino Miranda
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dina N Greene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington; LetsGetChecked Laboratories, Monrovia, California
| | - David Collister
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Sofia B Ahmed
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Kidney Disease Network, Calgary, Alberta, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, Boston, Massachusetts; Department of Nephrology, Beth Israel Deaconess Medical Centre, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Nathalie Saad
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christina C Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Krasowski MD, Hines NG, Imborek KL, Greene DN. Impact of sex used for assignment of reference intervals in a population of patients taking gender-affirming hormones. J Clin Transl Endocrinol 2024; 36:100350. [PMID: 38737625 PMCID: PMC11087993 DOI: 10.1016/j.jcte.2024.100350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/19/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
Background Gender-affirming hormone therapy with either estradiol or testosterone for transgender persons can significantly impact chemistry and hematology laboratory tests. The sex used for assignment of reference intervals (RIs) in the electronic health record (EHR) will influence normal/abnormal flagging of test results. Objective To analyze common non-hormonal laboratory tests with sex-specific RIs ordered in patients with sexual orientation/gender identify (SOGI) field differences (one or more differences between legal sex, sex assigned at birth, and gender identity) in the EHR at an academic medical center in midwestern United States. Methods We utilized a previously characterized data set of patients at our institution that included chart review information on gender identity and gender-affirming therapy. We focused on the subset of these patients that had orders for 18 common laboratory tests in calendar year 2021. Results A total of 1336 patients with SOGI field differences (1218 or 91.2% identifying as gender-expansive; 892 or 66.8% receiving estradiol or testosterone as gender-affirming therapy) had a total of 9374 orders for 18 laboratory tests with sex-specific RIs. Hemoglobin, creatinine, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and high-density lipoprotein were the most frequently ordered tests. For patients taking estradiol, 128 of 970 (13.2%) creatinine and 39 of 193 (20.2%) hemoglobin measurements were within the RI for one sex but not the other. For those taking testosterone, 119 of 531 (22.4%) creatinine and 49 of 120 (40.8%) hemoglobin measurements were within the RI for one sex but not the other. Values above the cisgender female RI but within the cisgender male RI were common for hemoglobin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase in patients taking testosterone. Conclusions Clinicians should be aware of the potential impact of gender-affirming therapy on laboratory tests and what sex/gender is being used in the EHR to assign RIs.
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Affiliation(s)
- Matthew D. Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Nicole G. Hines
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
- Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | | | - Dina N. Greene
- Department of Laboratory Medicine, University of Washington, Seattle, WA, 98195, USA
- LetsGetChecked Laboratories, Monrovia, CA, 91016, USA
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7
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Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
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Torres C, Muldrow RA, Naranjo AR, Cotten SW, Pierre CC, Greene DN. Development and validation of an LC-MSMS method to quantify creatinine from dried blood spots. J Mass Spectrom Adv Clin Lab 2024; 32:50-59. [PMID: 38511102 PMCID: PMC10950697 DOI: 10.1016/j.jmsacl.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/16/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Screening for chronic kidney disease relies on accurate and precise creatinine measurements. Traditionally, creatinine is measured in serum or plasma using high-throughput chemistry analyzers. However, dried blood spots (DBS) can also be utilized to improve testing access. Methods Samples were obtained from a 6 mm DBS punch, which was reconstituted in water before undergoing an acetonitrile crash. The resulting supernatant was diluted using an 80:20 acetonitrile: water before injection. Creatinine was identified using an isocratic gradient, and detected using an API 4000 triple quadrupole mass analyzer. Quantification relied on matrix-matched calibrators, with values harmonized to the Roche Cobas enzymatic assay. Validation studies assessing method performance included precision, linearity, accuracy, method comparison, stability, interference, and matrix effects. Results The LC-MSMS assay was linear from 0.3 to 20 mg/dL (y = 1.02x-0.11; R2 = 0.996). Precision ranged from 5.2 to 8.1 % using matrix-matched controls (n = 4) that spanned the analytical measurement range. LC-MSMS results corresponded to the enzymatic assay (Roche) with a fitted line equation of y = 0.956x-0.07 (R2 = 0.995; n = 173). The Siemens and Roche enzymatic assays demonstrated higher accuracy in correlating to the DBS creatinine concentration (n = 40 paired venous/DBS collections) compared to the Beckman Jaffe assay (-2.5 % and -0.8 % versus -6.3 % and -4.1 %, respectively) or the iSTAT (-28.4 % and -27.1 %, respectively). Accuracy was unaffected by hematocrit, blood spot volume, excess IgG or IgA, or hypertriglyceridemia. No matrix effects were observed, and both extraction and processing efficiency were robust.Ambient stability extended to at least 10 days, and exposure to extreme temperature did not affect the creatinine results. Conclusion We successfully developed an accurate and precise LC-MSMS method for quantifying creatinine in DBS.
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Affiliation(s)
| | | | | | - Steven W. Cotten
- Department of Pathology and Laboratory Medicine, Chapel Hill, NC, USA
| | - Christina C. Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Hospital, Lancaster, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dina N. Greene
- LetsGetCheked, Monrovia, CA, USA
- University of Washington Seattle, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
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Farrell DR, Vassalotti JA. Screening, identifying, and treating chronic kidney disease: why, who, when, how, and what? BMC Nephrol 2024; 25:34. [PMID: 38273240 PMCID: PMC10809507 DOI: 10.1186/s12882-024-03466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
1 in 7 American adults have chronic kidney disease (CKD); a disease that increases risk for CKD progression, cardiovascular events, and mortality. Currently, the US Preventative Services Task Force does not have a screening recommendation, though evidence suggests that screening can prevent progression and is cost-effective. Populations at risk for CKD, such as those with hypertension, diabetes, and age greater than 50 years should be targeted for screening. CKD is diagnosed and risk stratified with estimated glomerular filtration rate utilizing serum creatinine and measuring urine albumin-to-creatinine ratio. Once identified, CKD is staged according to C-G-A classification, and managed with lifestyle modification, interdisciplinary care and the recently expanding repertoire of pharmacotherapy which includes angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers, sodium-glucose-cotransporter-2 inhibitors, and mineralocorticorticoid receptor antagonists. In this paper, we present the why, who, when, how, and what of CKD screening.
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Affiliation(s)
- Douglas R Farrell
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, 10029, New York, NY, USA.
| | - Joseph A Vassalotti
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, 10029, New York, NY, USA
- National Kidney Foundation, Inc, New York, NY, USA
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Charles K, Lewis MJ, Montgomery E, Reid M. The 2021 Chronic Kidney Disease Epidemiology Collaboration Race-Free Estimated Glomerular Filtration Rate Equations in Kidney Disease: Leading the Way in Ending Disparities. Health Equity 2024; 8:39-45. [PMID: 38250300 PMCID: PMC10797164 DOI: 10.1089/heq.2023.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose In 2020, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) convened a Task Force to recommend an evidence-based race-free approach to estimated glomerular filtration rate (eGFR). After the rigorous review of more than 20 approaches, the NKF/ASN Task Force published the final report that recommended the implementation of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI 2021) equation for eGFR using creatine and expanded utilization of cystatin C testing. The purpose of this manuscript is to provide a comprehensive overview of the evolution of eGFR equations, and an overview of the Task Force deliberations and recommendations. For over two decades, the equation recommended to calculate eGFR included a race coefficient to adjust for data that suggested that American adults with African ancestry had consistently higher serum creatinine levels. Methods We will provide a discussion illustrating why the 2021 CKD EPI equations are the most equitable solution to eGFR. We will also provide an overview of the current implementation status and best practices for the new equations. Lastly, we will discuss how deployment of the new equations is an important step toward eliminating significant disparities in CKD care which disproportionately affect communities of color. Results Removing race from the algorithm used to assess kidney function is most equitable. Since race is a social construct, its use in clinical algorithms has facilitated health disparities in Black/African American people, Hispanic/Latino people, and other racial and ethnic minority groups-those who are already disproportionately impacted by diabetes, hypertension, and kidney disease. In turn, these same individuals experience significant inequities in kidney health care including reduced access to nephrology care, home dialysis, and kidney transplant. Conclusions Adoption of the race-free 2021 CKD-EPI eGFR equations will have life changing implications for kidney health. It will aid in appropriate referral, identification, diagnosis, treatment, and management of kidney disease and transplantation services/options. The outcomes of widespread implementation of the new equations coupled with system change quality improvement interventions such as the kidney profile will lead to more equitable outcomes and begin to address the crippling disparities in early, appropriate testing for CKD.
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Affiliation(s)
| | | | | | - Morgan Reid
- National Kidney Foundation, New York, New York, USA
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11
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Miller WG, Levey AS. It's Time to Standardize Laboratory Testing for Kidney Disease. J Appl Lab Med 2023:jfad031. [PMID: 37379074 DOI: 10.1093/jalm/jfad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 06/29/2023]
Affiliation(s)
- W Greg Miller
- Virginia Commonwealth University, Richmond, VA, United States
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