Elimination of Race for EGFR Calculation = Formula Change

[RickHow]

As we all know the usual EGFR Calculation takes your Creatinine level, Age, Sex, Race and calculates your EGFR. I get tested every 3 weeks. I always use the same lab. The results have always been equal to those I process myself using online calculators. Recently I notice that my EGFR levels were coming out 3 to 4 points higher than what they used to, but for the same Creatinine level. Also 3 to 4 points higher than when I did the calculations myself online. I questioned my doctor who does the testing. He checked and the lab assured him the recent calculations were correct. Yesterday I hand an appointment with my kidney doctor, who uses the same lab as my oncologist and primary care., She was aware of this. We discussed it. Many doctors have questioned the accuracy and in fact the entire theory of egfr calculation. How it labels people as diseased (ckD) when they are not necessarily so. If it is an accurate reflection of kidney function since it does not take into account medications being taken, other illnesses the patient has, one or two kidneys, etc. She said another big consideration is why the difference based upon Race. What makes a Black kidney require a different calculation than a White kidney. She said the reason was that Blacks generally have a higher muscle mass. But yet we all know Blacks that are in all shapes and sizes, so why this general distinction and categorizing all Whites the same, and all blacks the same. And why is there not a distinct calculation for Asians, or Latino's, etc. All this just showing yet another flaw in the EGFR Calculation. SO!!!!!!!!!! The local hospitals in our area and many throughout the state (new york), have eliminated the choice of race from the egfr calculator. IF the lab is given the persons age, height, weight, then they will use this information to calculate eGFR, and NOT race. Hence, is why my egfr has recently come out higher. IF the lab does not have the persons physical characteristics they will calculate the egfr for white, then the egfr for black, average the resulting calculations and pubish the egfr. They will in no case simply base the egfr on if you are white or black. My kidney doctor advised me, as she always has, to simply ignore the entire egfr classification. It is much easier and less worrisome to simply look at your Creatinine level with each test. Look for consistent results with variations between tests of just .3 or .2 tests (i.e., 1.5 to 1.8).

[Bassetmommer]

wow, Rick, this is great information. I have always said that the labs reports are good for trending but not determining diagnosis by one lab. And not taking in body mass for all people, not by race has always bugged me. Doctors who prescribe by the numbers and not by the person is not a good doctor. For example, saying that all people with GFR less than 15 should be automatically placed on dialysis is irresponsible.

Thanks for the info.

[RickHow in reply to Bassetmommer]

My kidney doctor was pleased with this change although as she said, it still does not account for other changes that are needed such as medications, other conditions, number of kidneys, etc., etc. AND it is not a universal change but just done by some hospitals of the United Healthcare grouping. In case you are interest here is a link to an online calculator that allows you to at least have the option to put in your own height and weight. It still forces you to choose between black and white (I wonder what are the asians, latinos, etc., supposed to do).Just enter your Creatinine, Age, Gender, Rack, leave the default for Standardized Assays, but for "remove body surfaces" be sure to select "yes". Then enter your height and weight. You will find that your resulting egfr increases SIGNIFICANTLY verus just using the default and not entering height and weight. FAR more accurate.

kidney.org/professionals/kd...

[Bassetmommer in reply to RickHow]

I tired this and was please to have 3 points more added to my GFR. May not be the actual reading but it made me feel good. Labs can be so depressing.

[RickHow in reply to Bassetmommer]

I too always get a higher egfr. I think it is at least more accurate than not entering height and weight. Without entering those the formula simply compares you to every other person of your age and race. CERTAINLY that can not be accurate. Think of the entire population your age. We are all the same? Or are some obese, are some at leave overweight for their height, are some more muscular, do some have other conditions and illness, etc., etc. A person our age, who has an average weight, is more thank likely to have a better kidney condition than one, for example, who is overweight (due to water retention, overeating, etc.). At the very least it all shows something should be done to develop a better formula for calculating a persons egfr. The one we have is far from good.

[Bassetmommer in reply to RickHow]

I still say the best indicator is how you feel. If you have a low GFR and feel fine, then... ok you're fine. Stick with the diet and any meds and see how it goes. There is no cure, we all know that. But there is a way to maintain and it works.

I know people who are totally a mess with a GFR of 30 or more. I think a lot has to do with attitude.

[RickHow in reply to Bassetmommer]

I agree one million per cent!! Attitude plays a very important part. I also have kidney cancer that spread to my bones. I go for treatments every 3 weeks. When I see so many other patients receiving their treatment and complaining (overly) about every ache and pain, or so depressed, etc., I think what a waste. None of us knows where I final day will come. Be it from any condition. So why sit and moan and waste the valuable days you are given. Especially as you say, there is no cure. So enjoy each morning you wake and are able to say "it's not happening today:.

[Bassetmommer in reply to RickHow]

YOU are a true Warrior. Best to you.

[RhenDutchess123]

I am a small female over 60...my GFR was at 12 for over a year., and I felt fine...I was encouraged to start PD anyway ...and I realized I wasnt feeling "fine"...and now I feel better each day....Kidney Disease is tricky...it generally happens so slow that we dont notice most symptoms...we just become accustomed to them...as we damage our other Organs by feeding them dirty blood..

[Marvin8]

I always felt that to ignore muscle mass when you're measuring creatinine is a little whacky. That's why Cystatin-C levels may be more a more accurate measure; it ignores muscle mass entirely.