AUA 2022: Race Based Equations for Estimating Kidney Function contribute to Racial Disparities In Partial Nephrectomy Utilization Among Black Patients with Kidney Tumors

( At the American Urological Association conference in New Orleans, 2022. Abdallah and colleagues from the Cleveland Clinic gave a poster presentation on the disparities that may arise between races and the types of surgeries they receive. Specifically, Abdallah et. Al. found that compared to other races, black Americans receive a higher number of radical nephrectomies than partial nephrectomies. This is a major problem due to black Americans being at higher risk of comorbidities and being diagnosed with chronic kidney disease (CKD). The team sought to out to find a reason behind these disparities.

When considering whether a patient should receive a partial nephrectomy (PN) or radical nephrectomy (RN), guidelines exist to aid physicians. Factors such as renal function, tumor size and location are all considered. Physiologically, black Americans typically see a higher estimated glomerular filtration rate (eGFR) which signifies a lower baseline kidney function. As a result, equations that are used to predict renal function factor this in when compared to other races. Due to the radicalization in eGFR, Abdallah and team predict there is a lower utilization of partial nephrectomies and higher chance for blacks to undergo radical nephrectomies based on the guidelines set.

Abdallah et. Al. took data from 2005-2020 which included 6476 consecutive patients who underwent PN or RN. Preoperative creatine was split into black and non-black patients and compared pre-operative and surgery types. The first table below show all factors that were considered and compared.



The figure shown above is multivariable logistic regression analysis, this analysis revealed that blacks were less likely to undergo a PN.



The Table above shows the CKD-EPI equation, an equation commonly used to estimate eGFR.

Abdallah and his team concluded that black Americans were less likely to undergo PN rather than RN despite having a lower baseline kidney function, being at higher at risk of developing CKD. Presenter Abdallah raised a valid limiting factor, the team didn’t know what the interaction between the physician and patient was stating “We do not know what goes on with doctor and patient, perhaps the patient is electing for a radical nephrectomy rather than a partial”. Another aspect the team considered is access to healthcare for these patients and if that has an effect outcome. These findings help give light to the disparities and should be carefully considered when moving further with black Americans and the types of nephrectomies they receive.

Presenter: Nour Abdallah, MD, Postdoctoral Research Fellow, Cleveland Clinic
Coauthors: Tarik Benidir, Martin Hofmann, Eiftu Haile, Diego Aguilar Palacios, Venkatesh Krishnamurthi, Samuel Haywood, Mohamed Eltemamy, Jihad Kaouk, Robert Abouassaly, Steven Campbell, Christopher Weight, Cleveland, OH

Written By: Paul Piedras, B.S., University of California, Irvine, @piedras_paul on Twitter, during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.