EGFR and chemotherapy: will removing race create disparities?

Abstract

Assessment of glomerular filtration rate (GFR) is necessary for determining eligibility and dosing of chemotherapeutic agents that are excreted by the kidney. Measured GFR (mGFR), determined from filtration marker clearance, is infrequent in clinical practice; instead, current guidelines recommend estimated GFR (eGFR) from serum creatinine (eGFRCr) in adults using the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) 2009 equation, which includes age, sex, and race. 1 Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work GroupKDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2012; 3: 1-150 Google Scholar As part of a broader movement to avoid potential racial bias in clinical algorithms, the US National Kidney Foundation and American Society of Nephrology have established a task force to consider removing race from GFR-estimating equations. 2 Delgado C Baweja M Burrows NR et al. Reassessing the inclusion of race in diagnosing kidney diseases: an interim report from the NKF-ASN task force. Am J Kidney Dis. 2021; 1: 103-115 Summary Full Text Full Text PDF Scopus (15) Google Scholar Several methods could be used; one commonly used method is to assign the non-Black eGFR value to Black patients. 3 Powe NR Black kidney function matters: use or misuse of race?. JAMA. 2020; 324: 737-738 Crossref PubMed Scopus (46) Google Scholar The effects on eGFR are easy to compute, but the effects on clinical practice have not yet been carefully studied. In The Lancet Oncology, Morgan Casal and colleagues 4 Casal MA Ivy SP Beumer JH Nolin TD Effect of removing race from glomerular filtration rate-estimating equations on anticancer drug dosing and eligibility: a retrospective analysis of National Cancer Institute phase 1 clinical trial participants. Lancet Oncol. 2021; (published online Aug 13.)https://doi.org/10.1016/S1470-2045(21)00377-6 Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar report the simulated effects of removing race from the CKD-EPI equation on eligibility and recommended dosage adjustments for ten chemotherapeutic agents for Black patients with cancer. Effect of removing race from glomerular filtration rate-estimating equations on anticancer drug dosing and eligibility: a retrospective analysis of National Cancer Institute phase 1 clinical trial participantsRemoving race from the CKD-EPI equation will calculate a lower eGFR for Black patients and exclude more patients from receiving anticancer therapy, which could lead to undertreatment of Black patients with cancer and adversely affect their outcomes. Full-Text PDF