{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:35:47Z","timestamp":1791416147718,"version":"4.3.3"},"reference-count":72,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001259","name":"National Kidney Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001259","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:p>Assessment of GFR is central to clinical practice, research, and public health. Current Kidney Disease Improving Global Outcomes guidelines recommend measurement of serum creatinine to estimate GFR as the initial step in GFR evaluation. Serum creatinine is influenced by creatinine metabolism as well as GFR; hence, all equations to estimate GFR from serum creatinine include surrogates for muscle mass, such as age, sex, race, height, or weight. The guideline-recommended equation in adults (the 2009 Chronic Kidney Disease Epidemiology Collaboration creatinine equation) includes a term for race (specified as black versus nonblack), which improves the accuracy of GFR estimation by accounting for differences in non-GFR determinants of serum creatinine by race in the study populations used to develop the equation. In that study, blacks had a 16% higher average measured GFR compared with nonblacks with the same age, sex, and serum creatinine. The reasons for this difference are only partly understood, and the use of race in GFR estimation has limitations. Some have proposed eliminating the race coefficient, but this would induce a systematic underestimation of measured GFR in blacks, with potential unintended consequences at the individual and population levels. We propose a more cautious approach that maintains and improves accuracy of GFR estimates and avoids disadvantaging any racial group. We suggest full disclosure of use of race in GFR estimation, accommodation of those who decline to identify their race, and shared decision making between health care providers and patients. We also suggest mindful use of cystatin C as a confirmatory test as well as clearance measurements. It would be preferable to avoid specification of race in GFR estimation if there was a superior, evidence-based substitute. The goal of future research should be to develop more accurate methods for GFR estimation that do not require use of race or other demographic characteristics.<\/jats:p>","DOI":"10.2215\/cjn.12791019","type":"journal-article","created":{"date-parts":[[2020,5,11]],"date-time":"2020-05-11T16:35:25Z","timestamp":1589214925000},"page":"1203-1212","source":"Crossref","is-referenced-by-count":251,"title":["Kidney Disease, Race, and GFR Estimation"],"prefix":"10.2215","volume":"15","author":[{"given":"Andrew S.","family":"Levey","sequence":"first","affiliation":[{"name":"Division of Nephrology, Tufts Medical Center, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia M.","family":"Titan","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Tufts Medical Center, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil R.","family":"Powe","sequence":"additional","affiliation":[{"name":"Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and University of California, San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Coresh","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley A.","family":"Inker","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Tufts Medical Center, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,5,11]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1038\/s41581-019-0213-9","article-title":"Strengths and limitations of estimated and measured GFR","volume":"15","author":"Levey","year":"2019","journal-title":"Nat Rev Nephrol"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.2215\/CJN.00710113","article-title":"World incidence of AKI: A meta-analysis","volume":"8","author":"Susantitaphong","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","year":"2018","journal-title":"Lancet"},{"key":"B4-20230813","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/S0140-6736(18)32203-7","article-title":"Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","year":"2018","journal-title":"Lancet"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/S0140-6736(13)60687-X","article-title":"Chronic kidney disease: Global dimension and perspectives","volume":"382","author":"Jha","year":"2013","journal-title":"Lancet"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"2167","DOI":"10.1681\/ASN.2016050562","article-title":"Global Cardiovascular and renal outcomes of reduced GFR","volume":"28","author":"Thomas","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"B7-20230813","author":"Saran"},{"key":"B8-20230813","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1046\/j.1523-1755.2003.00138.x","article-title":"To have and have not: Health and health care disparities in chronic kidney disease","volume":"64","author":"Powe","year":"2003","journal-title":"Kidney Int"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1053\/j.ajkd.2019.01.018","article-title":"CKD progression: Teasing out contributions of elements in the human exposome","volume":"73","author":"Powe","year":"2019","journal-title":"Am J Kidney Dis"},{"key":"B10-20230813","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1097\/MNH.0b013e32835012ab","article-title":"APOL1 and kidney disease","volume":"21","author":"Pollak","year":"2012","journal-title":"Curr Opin Nephrol Hypertens"},{"key":"B13-20230813","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1038\/ng1101-239","article-title":"Genes, drugs and race","volume":"29","year":"2001","journal-title":"Nat Genet"},{"key":"B15-20230813","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1056\/NEJMsb025007","article-title":"The importance of race and ethnic background in biomedical research and clinical practice","volume":"348","author":"Burchard","year":"2003","journal-title":"N Engl J Med"},{"key":"B16-20230813","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1126\/science.1074447","article-title":"Genetics. 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