Date

8-29-2024

Department

School of Nursing

Degree

Doctor of Nursing Practice (DNP)

Chair

Kenneth Thompson

Keywords

eGFR, race modifier, renal disease, disparity, GFR, risk for renal disease

Disciplines

Bioethics and Medical Ethics | Nursing

Abstract

The purpose of this study was to understand if the use of eGFR (CKD-EPI 2021) in the absence of race modification influenced early detection of renal disease for veterans managed by patient-aligned care teams. A retrospective cohort study design was used, analyzing patient data from the Department of Veterans Affairs Medical Center (VAMC). The study included veterans with available serum creatinine, albumin, eGFR, CKD-EPI 2021, etc. measurements and demographic data. The study employed a systematic data review of electronic medical records from 2019 to 2024 and utilized electronic data collection through a computerized patient record system (CPRS) data collection system. No human subjects participated in this study. This project was approved by the Liberty University Research Ethics Review Board. The study found that the use of the CKD-EPI 2021 equation without race modifiers resulted in a reclassification of CKD stages for a significant proportion of veterans, particularly those previously classified as having mild or moderate CKD. The reclassification generally indicated a higher prevalence of CKD when race was not considered, suggesting that the traditional method may underestimate the severity of kidney disease in certain populations. To improve standardized chronic renal disease prevention, detection, and management of renal disease, institutional at-risk for renal disease risk indicators have to also be standardized. The elimination of professional bias in the decision-making process.

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