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Screening for Chronic Kidney Disease Complications in US Adults: Racial Implications of a Single GFR Threshold

Hassan N. Ibrahim^*, Changchun Wang, Areef Ishani^*,, Allan J. Collins^*,, and Robert N. Foley^*,

^* Department of Medicine, University of Minnesota, and United States Renal Data System Coordinating Center, Minneapolis, Minnesota

Correspondence: Dr. Robert N. Foley, United States Renal Data System, 914 South 8th Street, Suite S-406, Minneapolis, MN 55404. Phone: 612-347-5979; Fax: 612-347-5878; E-mail: rfoley{at}usrds.org

Background and objectives: An ideal and effective screening tool should perform equally across ethnic groups. The objective of this study was to determine whether the widely advocated creatinine-based estimated GFR (eGFR) threshold of 60 ml/min per 1.73 m² identifies the typical metabolic abnormalities related to chronic kidney disease equally well in minority and nonminority adults.

Design, setting, participants, & measurements: This objective was addressed using data for 8918 minority and nonminority adult participants in the National Health and Nutrition Examination Survey 2003 through 2006, which used stratified, multistage, probability sampling methods to assemble a nationwide probability sample of the noninstitutionalized population of the United States. Metabolic abnormalities including BP, potassium, hemoglobin, bicarbonate, uric acid, calcium, phosphorus, and parathyroid hormone were defined by fifth or 95th percentile values.

Results: Among participants with eGFR <60 ml/min per 1.73 m², black individuals were more likely than white individuals to have low hemoglobin (adjusted odds ratio [aOR] 3.76; 95% confidence interval [CI] 1.94 to 7.28), elevated uric acid (aOR 2.15; 95% CI 1.26 to 3.68), and elevated parathyroid hormone (aOR 3.93; 95% CI 2.33 to 6.66).

Conclusions: Metabolic consequences of reduced eGFR are more common in black individuals and seem to be present at levels well above 60 ml/min per 1.73 m²; thus, black individuals should be screened for the metabolic complications of chronic kidney at higher GFR levels.

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Clin. J. Am. Soc. Nephrol. 2009 4: 251-253. [Full Text] [PDF]

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				C. A. Gadegbeku and G. M. Chertow Cum Hoc, Ergo Propter Hoc: Health Disparities Real and Imagined Clin. J. Am. Soc. Nephrol., February 1, 2009; 4(2): 251 - 253. [Full Text] [PDF]