The Implication of Dropping Race from the MDRD Equation to Estimate GFR in an African American-Only Cohort

The widely used Modification of Diet in Renal Disease (MDRD) formula adapts a 1.212 multiplier for individuals who are identified as African Americans (AAs) or Blacks, which leads to a higher GFR estimation. As it stands, AAs have a lower prevalence of chronic kidney disease (CKD) but higher incidence of end-stage renal disease (ESRD) compared with Whites. Many hypotheses have been postulated to explain this paradox, but the imprecision of the GFR estimation with race-adaptation could be contributory. We performed a single-center, longitudinal, retrospective study on a cohort of outpatient AA patients using the MDRD and MDRDrace removed and CKD-EPI and CKD-EPIrace removed and their progression to CKD G5 (eGFR <15 ml/min/1.73 m2). 327 patients were analyzed. Median follow-up was 88.1 months (interquartile range, 34.4–129.1). When race was removed from MDRD, 39.9% of patients in CKD G1/2 were reclassified to CKD G3a, 72.6% of patients in CKD G3a would be reclassified to CKD G3b, and 54.1% and 36.4% of patients would be reclassified from CKD 3b to CKD G4 and CKD G4 to CKD G5, respectively p < 0.0001 . Comparing the CKD-EPI formula against the MDRD in our cohort, we found that 8.2%, 18.8%, and 11.4% of patients were reclassified from CKD G1/2 to CKD G3a, CKD G3a to G3b, and CKD G3b to CKD G4 respectively. Overall median time to progression to CKD G5 was 137.4 (131.9–142.8) months in patients who were not reclassified and 133.6 (127.6–139.6) months for patients who were reclassified by MDRDrace removed p < 0.288 . Concerns of inequitable access to healthcare have elicited calls to review race-corrected eGFR equations. A substantial number of individuals would have their CKD stage reclassified should have the MDRDrace removed equation be adopted en masse on an AA-only population. The discrepancy is highest at the 45–59 and >60 ml/min/1.72 min2 ranges. This will have tremendous impact on our center’s approach to pharmacological dosing, referral system, best practices, and outcome surveillance. Comprehensive review of the current “race-corrected” eGFR will require a multifaceted approach and adjunctive use of noncreatinine-based approach.

A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease

A Task Force from the NKF and ASN developed recommendations for reassessing inclusion of race in the estimation of glomerular filtration rate (eGFR) in the U.S. The Task Force recommends immediate implementation of the CKD-EPI creatinine equation refit without the race variable in all laboratories because the calculation does not include race, it included diversity in its development, its potential adverse consequences do not disproportionately affect any one group, and it is immediately available to all laborataries. A second recommendation calls for national efforts to facilitate increased, routine, and timely use of cystatin C, especially to confirm eGFR in adults for clinical decision-making. A third recommendation encourages research on GFR estimation with new endogenous filtration markers and interventions to eliminate racial and ethnic disparities.

Clinical Implications of the New Equation to Estimate Glomerular Filtration Rate

Recently, a new full-age spectrum equation was proposed by the European Kidney Function Consortium (EKFC) to overcome the difficulty of using multiple glomerular filtration rate (GFR) estimation equations and problems of implausible changes in GFR during the transition from adolescence to adulthood and address GFR overestimation in young adults and in the older adults. To verify the impact on patient classifications, we applied the new equation to data of 38,188 adult patients, comparing GFR estimation using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and EKFC equations. As expected, our data indicate that a significant proportion of patients will be reclassified downward by the EKFC compared to the CKD-EPI equation with a particular reference between CKD stages 1–2 and 2–3 and age categories of 18–30 and ≥61 years, respectively. Clinicians should be aware that any replacement for the EKFC equation will entail a period of different results in estimated GFR during the transition from the previous to the new equation.

Differential GFR estimation of the double moiety kidneys by modified GATE’S formula

Since the beginning of the twenty-one century, carbon based nanomaterial (CNTs) has been introduced in (pharmacy and medicine) in therapeutic for system of drug delivery. NTs have proved able to transport a wide range of molecules across membranes and into living cells; therefore, they have attracted great interest in biomedical applications such as advanced imaging, tissue regeneration, and drug or gene deliver. As it is known, carbon nanotubes exhibit various unique intrinsic chemical and physical properties and it has been intensive explored, in the last few years, for applications in biology and biomedicine.

Comparative Assessment of Glomerular Filtration Rate (GFR) Google APPs and CKD Prepare GFR India Google App

Aim: Glomerular filtration rate (GFR) estimation is an important parameter for assessment of kidney function and management of the patient with suspected kidney function. These mobile applications hence change the way better patient care is managed. In the research project, there is an attempt to perform comparative assessment of GFR Google APPs and CKD PREPARE GFR India Google APP. Methods: Google app store was searched to identify all the applications which may help in estimation of GFR. All the application were compared except general medical calculators and non-English applications. All important parameters were identified with the guidance of delphi group and comparison chart was made. Results: The search of Google play store led to 35 mobile applications related to GFR estimation. The majority of the applications were by IT company developers and few were by associations or individuals. There are few companies who have developed multiple mobile applications with different formulas. Many of these aspects of the mobile applications which are considered had important parameters. Few of the applications have multiple page interfaces which may lead to multiple clicks before reaching to GFR estimation which may be at times may be difficult in case of large amounts of use. Conclusion: All the GFR estimation applications are comparable. Single user interface applications have advantages over others where all the data can be entered and results are available in a single view. The disclaimer of using calculators under medical guidance of a qualified physicians is always required.