Association of the Estimated Glomerular Filtration Rate With vs Without a Coefficient for Race With Time to Eligibility for Kidney Transplant.
Association of the Estimated Glomerular Filtration Rate With vs Without a Coefficient for Race With Time to Eligibility for Kidney Transplant.
复制标题
DOI：
10.1001/jamanetworkopen.2020.34004
复制
发表时间：
2021-01-04
影响因子：
13.8
通讯作者：
Bansal N
中科院分区：
文献类型：
--
作者：
Zelnick LR;Leca N;Young B;Bansal N
本队列研究评估了计算的估计肾小球滤过率（eGFR）（有vs无人种系数）与达到eGFR小于20 mL/min/1.73 m2的时间之间的相关性。在慢性肾脏病患者肾小球滤过率估计方程中校正黑人是否与肾移植资格延迟相关？在这项队列研究中，1658名自认为患有慢性肾脏疾病的黑人成年人，常用的肾功能估计值与直接测量的肾功能不一致。估计不包括人种系数的肾功能（vs包括人种系数）与达到估计肾小球滤过率小于20 mL/min/1.73 m2的时间较短显著相关，这是转诊和登记肾移植的关键肾功能阈值。研究结果表明，基于种族的肾小球滤过率估计值的偏差可能与潜在肾移植资格的延迟有关。肾移植与肾衰竭患者的生存率和生活质量改善相关;然而，在移植获得方面存在显著的种族差异。估计肾小球滤过率（eGFR）的常用方程包括对黑人人种的校正;然而，在常用eGFR方程中纳入人种系数如何与测量的GFR相对应，以及其是否与延迟肾移植资格列表相关尚不清楚。比较eGFR与测量的GFR，并评价计算的eGFR与不计算人种和至肾移植资格时间系数之间的相关性。这项前瞻性队列研究使用了来自慢性肾功能不全队列的数据，这是一项针对慢性肾脏疾病（CKD）参与者的多中心队列研究。该研究中自我确认的黑人参与者于2003年4月至2008年9月期间入组，随访至2018年12月。统计分析于2020年11月11日完成。GFR估计值，每年测量一次，并使用基于肌酐的慢性肾脏疾病流行病学（CKD-EPI）方程（含和不含种族系数）进行估计。在一个受试者亚组（n = 311）中测量的碘酞酸盐GFR（iGFR）和达到eGFR小于20 mL/min/1.73 m2（肾移植转诊和列名的既定阈值）的时间。在1658名自我认定的黑人参与者中，平均（SD）年龄为58（11）岁，848（51%）名为女性，平均（SD）eGFR为44（15）mL/min/1.73 m2。CKD-EPI eGFR和种族系数高估了iGFR，平均值为3.1 mL/min/1.73 m2（95% CI，2.2 - 3.9 mL/min/1.73 m2; P <0.001）。CKD-EPI eGFR（不含种族系数）与iGFR之间的平均差异较小（− 1.7 mL/min/1.73 m2; 95% CI，− 2.5至− 0.9 mL/min/1.73 m2）。对于iGFR为20至25 mL/min/1.73 m2的受试者，有与无种族系数和iGFR的eGFR平均差异为5.1 mL/min/1.73 m2（95% CI，3.3 - 6.9 mL/min/1.73 m2）与1.3 mL/min/1.73 m2（95% CI，− 0.3至2.9 mL/min/1.73 m2）。中位随访时间为4年（四分位距，1 - 10年），使用不含种族系数的eGFR计算值与使用种族系数计算值相比，达到eGFR低于20 mL/min/1.73 m2的风险高35%（95% CI，29%-41%），达到该终点的中位时间较短（1.9年）。在这项队列研究中，在GFR估计中纳入种族系数与GFR估计的较大偏倚以及延迟达到肾移植转诊和资格的临床阈值相关。这些发现表明，肾脏病学家和移植计划应谨慎使用目前的估计方程，以确定肾移植资格。
This cohort study assesses the association between estimated glomerular filtration rate (eGFR) calculated with vs without a coefficient for race and time to achievement of an eGFR less than 20 mL/min/1.73 m2. Is adjusting for Black race in estimating equations for glomerular filtration rate in patients with chronic kidney disease associated with a delay in kidney transplant eligibility? In this cohort study of 1658 self-identified Black adults with chronic kidney disease, commonly used estimates of kidney function did not correspond well with directly measured kidney function. Estimating kidney function not including a coefficient for race (vs including a race coefficient) was significantly associated with a shorter time to achieving an estimated glomerular filtration rate less than 20 mL/min/1.73 m2, a key threshold of kidney function for referral and listing for kidney transplant. The findings suggest that biases in race-based glomerular filtration rate estimates may be associated with delays in potential kidney transplant eligibility. Kidney transplant is associated with improved survival and quality of life among patients with kidney failure; however, significant racial disparities have been noted in transplant access. Common equations that estimate glomerular filtration rate (eGFR) include adjustment for Black race; however, how inclusion of the race coefficient in common eGFR equations corresponds with measured GFR and whether it is associated with delayed eligibility for kidney transplant listing are unknown. To compare eGFR with measured GFR and evaluate the association between eGFR calculated with vs without a coefficient for race and time to eligibility for kidney transplant. This prospective cohort study used data from the Chronic Renal Insufficiency Cohort, a multicenter cohort study of participants with chronic kidney disease (CKD). Self-identified Black participants from that study were enrolled between April 2003 and September 2008, with follow-up through December 2018. Statistical analyses were completed on November 11, 2020. Estimated GFR, measured annually and estimated using the creatinine-based Chronic Kidney Disease-Epidemiology (CKD-EPI) equation with and without a race coefficient. Iothalamate GFR (iGFR) measured in a subset of participants (n = 311) and time to achievement of an eGFR less than 20 mL/min/1.73 m2, an established threshold for kidney transplant referral and listing. Among 1658 self-identified Black participants, mean (SD) age was 58 (11) years, 848 (51%) were female, and mean (SD) eGFR was 44 (15) mL/min/1.73 m2. The CKD-EPI eGFR with the race coefficient overestimated iGFR by a mean of 3.1 mL/min/1.73 m2 (95% CI, 2.2-3.9 mL/min/1.73 m2; P < .001). The mean difference between CKD-EPI eGFR without the race coefficient and iGFR was of smaller magnitude (−1.7 mL/min/1.73 m2; 95% CI, −2.5 to −0.9 mL/min/1.73 m2). For participants with an iGFR of 20 to 25 mL/min/1.73 m2, the mean difference in eGFR with vs without the race coefficient and iGFR was 5.1 mL/min/1.73 m2 (95% CI, 3.3-6.9 mL/min/1.73 m2) vs 1.3 mL/min/1.73 m2 (95% CI, −0.3 to 2.9 mL/min/1.73 m2). Over a median follow-up time of 4 years (interquartile range, 1-10 years), use of eGFR calculated without vs with the race coefficient was associated with a 35% (95% CI, 29%-41%) higher risk of achieving an eGFR less than 20 mL/min/1.73 m2 and a shorter median time to this end point of 1.9 years. In this cohort study, inclusion of the race coefficient in the estimation of GFR was associated with greater bias in GFR estimation and with delayed achievement of a clinical threshold for kidney transplant referral and eligibility. These findings suggest that nephrologists and transplant programs should be cautious when using current estimating equations to determine kidney transplant eligibility.
登录
查看更多内容
DOI：
10.1056/nejmoa1114248
发表时间：
2012-07-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Inker LA;Schmid CH;Tighiouart H;Eckfeldt JH;Feldman HI;Greene T;Kusek JW;Manzi J;Van Lente F;Zhang YL;Coresh J;Levey AS;CKD-EPI Investigators
通讯作者：
CKD-EPI Investigators
DOI：
10.2215/cjn.04260415
发表时间：
2015-11-01
影响因子：
9.8
作者：
Denker, Matthew;Boyle, Suzanne;Feldman, Harold I.
通讯作者：
Feldman, Harold I.
影响因子：
16.9
作者：
Kulkarni, Sanjay;Ladin, Keren;Deng, Yanhong
通讯作者：
Deng, Yanhong
影响因子：
4.2
作者：
Joffe, Marshall;Hsu, Chi-Yuan;Hamm, L. Lee
通讯作者：
Hamm, L. Lee
影响因子：
5.5
作者：
Levin, Adeera;Stevens, Paul E.
通讯作者：
Stevens, Paul E.