Mp77-16 Impact of the Race-Coefficient to Estimate Egfr on the Management of Muscle Invasive Bladder Cancer

You have accessJournal of UrologyBladder Cancer: Invasive VI (MP77)1 May 2024MP77-16 IMPACT OF THE RACE-COEFFICIENT TO ESTIMATE EGFR ON THE MANAGEMENT OF MUSCLE INVASIVE BLADDER CANCER Amir Khan, Shu Wang, Rehan Choudhry, Kathryn H. Barry, Eberechukwu Onukwugha, Michael Phelan, and Mohummad Minhaj Siddiqui Amir KhanAmir Khan , Shu WangShu Wang , Rehan ChoudhryRehan Choudhry , Kathryn H. BarryKathryn H. Barry , Eberechukwu OnukwughaEberechukwu Onukwugha , Michael PhelanMichael Phelan , and Mohummad Minhaj SiddiquiMohummad Minhaj Siddiqui View All Author Informationhttps://doi.org/10.1097/01.JU.0001009404.49693.12.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Estimated glomerular filtration rate (eGFR) has historically been calculated inclusive of a race-coefficient; however, recently this race-coefficient has been broadly criticized. Among the management options for muscle invasive bladder cancer (MIBC), cisplatin-containing neoadjuvant chemotherapy (NAC) is a standard recommendation contingent on eGFR ≥60 mL/min/1.73 m2 to avoid potential complications. Herein, we evaluate whether an inappropriate race-coefficient in the eGFR equation exclusively for Black patients exposed them to increased complications. METHODS: We retrospectively analyzed the MIBC patients who underwent cystectomy in the ACS NSQIP database from 2006-2020. The eGFR was calculated using the Modification of Diet in Renal Diseases (MDRD) equation, with and without the race coefficient for Black patients. Similarly, an eGFR was calculated for non-Black cohort; without the race-coefficient (as done historically) and then with a simulated race-coefficient (1.212 equal to Black patients). This categorized the patients into three groups: eGFR consistently ≥60 ml/min/1.73 m2, eGFR consistently <60 ml/min/1.73 m2 and eGFR changing with race. Statistical tests as appropriate were employed wherever needed and statistical significance was set at p-value<0.05. RESULTS: Among a total of 15,245 participants, Black patients constituted 5.46% (vs 94.54% non-Black cohort). Adding the race coefficient in the equation for Black patients led to an increase in mean eGFR (from 57.8 to 70.0 ml/min/1.73 m2, p=0.001) and the proportion of eligible patients for cisplatin NAC increased by 17.3% (p=0.001). Similarly, these metrics increased in non-Black cohort (both p=0.001). On a multivariable- adjusted logistic regression model odds of developing cardiovascular and pulmonary (CV&P) complications in the 17.3% Black patients, rendered eligible for cisplatin NAC solely due to of race-coefficient (yellow bar), were 2.2 times higher compared to non-Black cohort rendered eligible for NAC solely due to race (yellow bar), (OR=2.2, p=0.02). CONCLUSIONS: Race-based estimations of eGFR exclusively for Black patients may inappropriately increase eligibility for certain treatment options which may lead to increased complications. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1259 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Amir Khan More articles by this author Shu Wang More articles by this author Rehan Choudhry More articles by this author Kathryn H. Barry More articles by this author Eberechukwu Onukwugha More articles by this author Michael Phelan More articles by this author Mohummad Minhaj Siddiqui More articles by this author Expand All Advertisement PDF downloadLoading ...