New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race.
New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race.
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DOI：
10.1056/nejmoa2102953
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发表时间：
2021-11-04
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影响因子：
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通讯作者：
Chronic Kidney Disease Epidemiology Collaboration
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文献类型：
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作者：
Inker LA;Eneanya ND;Coresh J;Tighiouart H;Wang D;Sang Y;Crews DC;Doria A;Estrella MM;Froissart M;Grams ME;Greene T;Grubb A;Gudnason V;Gutiérrez OM;Kalil R;Karger AB;Mauer M;Navis G;Nelson RG;Poggio ED;Rodby R;Rossing P;Rule AD;Selvin E;Seegmiller JC;Shlipak MG;Torres VE;Yang W;Ballew SH;Couture SJ;Powe NR;Levey AS;Chronic Kidney Disease Epidemiology Collaboration
目前使用血清肌酐或胱抑素C估计肾小球滤过率(EGFR)的公式包括年龄、性别和种族，以估计测量的GFR。然而，在EGFR方程中，种族是一种社会结构，而不是一种生物结构。我们使用来自两个发展数据集的数据建立了新的无RACE的EGFR方程：10项研究(8254名参与者，31.5%黑色)关于血清肌酐和13项研究(5352名参与者，39.7%黑色)血清肌酐和胱抑素C。在12项研究(4050名参与者，14.3%黑色)的验证数据集中，我们比较了新的EGFR方程与测量的GFR的准确性。我们使用当前和新的公式，预测了美国成年人样本中慢性肾脏疾病(CKD)和GFR阶段的患病率。在验证数据集中，目前使用年龄、性别和种族的肌酐方程高估了黑人测量的GFR(中位数，每1.73平方米体表面积每分钟3.7毫升；95%可信区间[CI]，1.8至5.4)，非黑人高估了较小程度的GFR(中位数，每1.73平方米每分钟0.5毫升；95%可信区间，0.0至0.9)。当当前的EGFR方程中省略了对黑人种族的调整时，黑人测量的GFR被低估了(中位数，每1.73平方米每分钟7.1毫升；95%可信区间，5.9至8.8)。一个使用年龄、性别和省略种族的新方程低估了黑人测量的GFR(中位数，每1.73平方米每分钟3.6毫升；95%可信区间，1.8~5.5)，高估了非黑人的测量GFR(中位数，每1.73平方米每分钟3.9ml；95%可信区间，3.4~4.4)。对于所有方程，黑人和非黑人的eGFR有85%或更多在测量的GFR的30%以内。不含RACE的新肌酐-胱抑素C方程比新的肌酐方程更准确，种族间差异较小。与目前的肌酐方程相比，新的肌酐方程，而不是新的肌酐-胱抑素C方程，增加了对黑人CKD患病率的人口估计，而在非黑人中得出了类似或更低的患病率。新的EGFR方程包含肌酐和胱抑素C，但省略了RACE，比没有单独包含肌酐或胱抑素C的新方程更准确，并导致黑人参与者和非黑人参与者之间的差异较小。(由国家糖尿病、消化和肾脏疾病研究所资助。)
Current equations for estimated glomerular filtration rate (eGFR) that use serum creatinine or cystatin C incorporate age, sex, and race to estimate measured GFR. However, race in eGFR equations is a social and not a biologic construct. We developed new eGFR equations without race using data from two development data sets: 10 studies (8254 participants, 31.5% Black) for serum creatinine and 13 studies (5352 participants, 39.7% Black) for both serum creatinine and cystatin C. In a validation data set of 12 studies (4050 participants, 14.3% Black), we compared the accuracy of new eGFR equations to measured GFR. We projected the prevalence of chronic kidney disease (CKD) and GFR stages in a sample of U.S. adults, using current and new equations. In the validation data set, the current creatinine equation that uses age, sex, and race overestimated measured GFR in Blacks (median, 3.7 ml per minute per 1.73 m2 of body-surface area; 95% confidence interval [CI], 1.8 to 5.4) and to a lesser degree in non-Blacks (median, 0.5 ml per minute per 1.73 m2; 95% CI, 0.0 to 0.9). When the adjustment for Black race was omitted from the current eGFR equation, measured GFR in Blacks was underestimated (median, 7.1 ml per minute per 1.73 m2; 95% CI, 5.9 to 8.8). A new equation using age and sex and omitting race underestimated measured GFR in Blacks (median, 3.6 ml per minute per 1.73 m2; 95% CI, 1.8 to 5.5) and overestimated measured GFR in non-Blacks (median, 3.9 ml per minute per 1.73 m2; 95% CI, 3.4 to 4.4). For all equations, 85% or more of the eGFRs for Blacks and non-Blacks were within 30% of measured GFR. New creatinine–cystatin C equations without race were more accurate than new creatinine equations, with smaller differences between race groups. As compared with the current creatinine equation, the new creatinine equations, but not the new creatinine–cystatin C equations, increased population estimates of CKD prevalence among Blacks and yielded similar or lower prevalence among non-Blacks. New eGFR equations that incorporate creatinine and cystatin C but omit race are more accurate and led to smaller differences between Black participants and non-Black participants than new equations without race with either creatinine or cystatin C alone. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.)