eGFR equation being updated to be less racist

[fifal9]

https://undark.org/2022/01/19/can-an-equation-to-help-determine-kidney-health-be-racist

The lab I use is in the midst of making this change. 

The new equation will use 'cystatin C' instead of creatinine. And there won't be different values for POC.

I hope it leads to more accurate results for everyone. If I see I big jump/drop in my numbers when it happens I'll post it here.

[iolaire]

Thanks, it will be interesting to see your changes. 

My September lab crop results showed the following and its been included in my lab work as far back as 01/03/2018:
eGFR If NonAfricn Am   64  mL/min/1.73   >59
eGFR If Africn Am 74 mL/min/1.73   >59
    
**Labcorp currently reports eGFR in compliance with the current recommendations of the National Kidney Foundation. Labcorp will update reporting as new guidelines are published from the NKF-ASN Task force.

Its amazing how little data (very small sample set of people) they based the calculations on
An early calculator to estimate kidney function, which used creatinine levels, was developed in 1973, based on data from only 249 White men. An eGFR equation using a more diverse population, called the MDRD, came in 1999, crafted by Andrew S. Levey who is now emeritus chief of nephrology at Tufts Medical Center. Levey and his colleagues included 197 participants who self-identified as Black, and included a term that adjusted the calculation for Black patients. A race modifier also appeared in an updated calculator, the CKD-EPI, developed in 2009 by Levey, Tufts nephrologist Lesley Inker, and several other investigators. In this case, the researchers studied more than 8,000 people to develop the equation, 30 percent of whom were Black, and validated it with group of nearly 4,000 people.

Even the new measure is probably based on rather small sample sets in the "20 studies" its built on.
The race-free calculator — called the eGFR 2021 CKD-EPI creatinine equation — pulls data from more than 20 studies at multiple institutions to validate its accuracy, says Inker.

[fifal9]

Hi iolaire! Those are great numbers. I hope they stay that high for you.

I'm also at Labcorp. I didn't realize they had been talking of change for so long, I only started using them a year ago and just recently noticed the footnote.  It would be nice if my bloodwork showed cystatin C so I could calculate it myself with an online calculator, but I haven't ever seen it listed on my results.

Hopefully it won't be another 4 years before they finally take action to change over.

[iolaire]

Hi I don’t know if this is new. More just pointing out what I see. My levels are post transplant.

[Simon Dog]

Were the levels racist or reflective of an actual difference between how the measured values in blacks relates to actual GFR?   The answer to this question seems evasive, since even asking the question would bring risk of denouncement in the medical setting.

I was turned down for Evoshed because I did "not need it badly enough".   The next time I am at the hospital, I am going to ask my doc if they are giving extra points based on the patient's race.

[fifal9]

Were the levels racist or reflective of an actual difference between how the measured values in blacks relates to actual GFR? 

A little bit of both.There were differences found overall in eGFR levels, but the older method was based on the idea that blacks have more muscle mass. “It goes back to slavery days where you would buy Black men based on their muscles,” per the article. 

The new equation will not solely use muscle mass, but also use cystatin C protein. 

This is good news not only for people who identify as black but also those who identify as mixed race, or those who have unusual muscle mass, such as body builders or those with a wasting disease.

From a different article I read today, only 270,000 doses of Evusheld have arrived in the US and only 700,000 additional doses have been secured for the near future.

https://www.precisionvaccinations.com/vaccines/evusheld-azd7442-long-acting-antibody
'UPMC said it has received 456 doses for at least 800,000 patients that qualify.' 

A lot of people want it and a lot of people are being turned down. 
If you manage to get one, buy a lottery ticket cuz it's your lucky day.

[iolaire]

This week's labcorp results have this note on GFR under the African American version:
**In accordance with recommendations from the NKF-ASN Task force,**
Labcorp is in the process of updating its eGFR calculation to the 2021 CKD-EPI creatinine equation that estimates kidney function without a race variable.

[fifal9]

On my latest lab results from tests taken on 3/5 the message now says:
**In accordance with recommendations from the NKF-ASN Task force,**
Labcorp has updated its eGFR calculation to the 2021 CKD-EPI
creatinine equation that estimates kidney function without a race variable

The eGFR is almost exactly the same as last month's tests. 2 points higher, but well within where my numbers fluctuate.
[/font]