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Interpreting an estimated glomerular filtration rate (eGFR) in people of black ethnicities in the UK

BMJ 2023 ; 380 doi: https://doi.org/10.1136/bmj-2022-073353 (Published 22 February 2023) Cite this as: BMJ 2023;380:e073353
  1. Kathryn Griffiths , clinical renal research fellow 1 2 ,
  2. Rouvick Mariano Gama , clinical renal research fellow 1 2 ,
  3. June Fabian , clinical researcher and honorary lecturer 3 ,
  4. Mariam Molokhia , clinical reader in epidemiology & primary care 4
  1. 1 King’s Kidney Care, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
  2. 2 Faculty of Life Sciences & Medicine, King’s College London, UK
  3. 3 Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
  4. 4 Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King’s College London, UK
  1. Correspondence to: K Griffiths Kathryngriffiths1{at}nhs.net

What you need to know

  • More people of black African or black Caribbean ethnicity will meet criteria for chronic kidney disease (CKD) diagnosis when ethnicity adjustment for estimated glomerular filtration rate (eGFR) calculation is not used

  • Classification and clinical coding of early CKD (including asymptomatic proteinuria) in primary care (including re-calculation of eGFR without adjustment) enables healthcare providers to systematically target interventions that aim to reduce cardiovascular events and progression to end stage kidney disease (ESKD)

  • Measure albumin creatinine ratio in addition to eGFR to identify patients at highest risk of adverse events (cardiovascular disease and ESKD)

A 37 year old man attends his GP for a review of his blood pressure. He was born in the UK, and his parents are from Nigeria. He was last reviewed three years ago, soon after being diagnosed with essential hypertension, and had been given lifestyle advice and prescribed amlodipine 5 mg daily. An estimated glomerular filtration rate (eGFR) adjusted for ethnicity was 75 mL/min/1.73 m 2 (serum creatinine 114 μmol/L), and urinary albumin creatinine ratio (ACR) was 2 mg/mmol. His chronic kidney disease (CKD) classification was G2A1 (low risk of adverse outcomes).

Today, his blood pressure averaged 145/90 mm Hg across three readings. He has been taking 5 mg amlodipine regularly. His eGFR is calculated without an ethnicity adjustment to be 58 mL/min/1.73 m 2 (serum creatinine 140 μmol/L). Clinical examination is unremarkable. A urine dipstick analysis shows no blood and 2+protein, and a urinary ACR identifies progression to macroalbuminuria (37 mg/mmol). An ultrasound scan of the urinary tract, electrocardiogram, and prostate specific antigen (PSA) test are normal.

Chronic kidney disease (CKD) with proteinuria is a stronger predictor of cardiovascular events than diabetes, leading to significant morbidity and mortality. 1 2 3 There is substantial inequality in CKD outcomes and clinical coding for people of black, Asian, and minority ethnicities in the UK. 4 In August 2021, updated CKD …

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