Chu CD, Powe NR, Crews DC, et al. - In Black and Hispanic patients, a less chance of being placed on the kidney transplant waitlist was observed in relation to a uniform eGFR threshold. Substantially earlier waitlisting for many Black patients would be achieved via GFR estimation as if their race category were non-Black, however, this would not eliminate their shorter time to kidney failure with replacement therapy (KFRT) as well as decreased opportunity for preemptive transplantation relative to White patients.

• eGFR equations that include a term for race assign a higher value to Black people than non-Black persons not attributable to gender, age, or serum creatinine.

• This is a retrospective cohort study of 40,042 White, 8,519 Black, and 3,569 Hispanic patients.

• KFRT cumulative incidence by 3 years was 20.5% in White patients, 40.9% in Hispanic patients, and 36% in Black patients whose eGFR was calculated employing a race term coded as Black.

• Such incidence was 28.7% in Black patients whose eGFR was estimated applying a race term coded as non-Black.

• KFRT risk continued to be greater in Black (HR 1.28) and Hispanic (HR 1.66) vs in White patients, in fully adjusted analyses with 11,269 Black patients with an eGFR <20 ml/min/1.73m ² based on coding them as non-Black.

• According to slopes of eGFR reduction, earlier waitlist activation by an estimated median of 0.5 years would be permitted by coding Black patients as non-Black.