Introduction: The estimated glomerular filtration rate (eGFR) equation is based on several factors among which the race factor has been broadly criticized. In September 2021, the National Kidney Foundation and American Society of Nephrology Task Force announced a new race-free calculation for eGFR. Aspects of treatment decisions for muscle-invasive bladder cancer (MIBC) are dependent on eGFR, specifically neoadjuvant cisplatin eligibility and choice of diversion with cystectomy. Herein, we evaluate the impact of removal of race-based eGFR calculation on the management of patients with MIBC. Methods: Using the National Surgical Quality Improvement Program database, adult patients diagnosed with MIBC and who received radical cystectomy from 2015 to 2020 were included in this study. eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) equation. We calculated the proportion of African American patients who were candidates for neobladder urinary diversions and cisplatin-based chemotherapy using >30 and >60 ml/min/1.73m2 as the cutoff for eGFR, respectively, as calculated with and without the race factor. Results: African Americans constituted 4.5% (579) of the total sample population (12,192) among which 39.7% (230) were female and 60.3% (349) were male. There was no association of eGFR with gender. Using the MDRD equation, the mean eGFR decreased from 70.0 to 57.8 ml/min/1.73m2 after removing the race factor. With the adjusted eGFR without race, 4.1% fewer patients (94.6% vs 90.5%) were eligible for neobladder urinary diversion with a >30 ml/min/1.73m2 eGFR cutoff. Furthermore, among patients who were previously eligible to receive cisplatin chemotherapy, 18.0% fewer patients (63.0% vs 45.0%) would remain eligible with a >60 ml/min/1.73m2 eGFR. (Figure 1) Conclusions: Excluding race from the eGFR equation will preclude some previously eligible African American patients for certain treatment in bladder cancer management. Further studies are needed to understand the relative risks and benefits of decisions that are based on the adjusted eGFR. SOURCE OF Funding: No source of funding.
