Race Adjustment in eGFR Equations Does Not Improve Estimation of Acute Kidney Injury Events in Patients with Cirrhosis.
Race Adjustment in eGFR Equations Does Not Improve Estimation of Acute Kidney Injury Events in Patients with Cirrhosis.
复制标题
DOI：
10.1007/s10620-021-06943-1
复制
发表时间：
2022-04
影响因子：
3.1
通讯作者：
Serper M
中科院分区：
文献类型：
--
作者：
Mahmud N;Asrani SK;Reese PP;Kaplan DE;Taddei TH;Nadim MK;Serper M
肾小球滤过率估计（eGFR）方程的准确性在肝硬化中具有重要意义，可能指导同时进行的肝肾分配和药物剂量。大多数方程都针对黑人种族进行了调整，部分原因是不同种族的肌肉质量存在差异。然而，肝硬化患者容易出现肌肉减少症，这可能会减轻这种差异。我们评估了基线eGFR与有或没有种族调整的肝硬化患者急性肾损伤（AKI）之间的关系。我们对患有肝硬化的退伍军人进行了一项回顾性全国队列研究。基线eGFR使用多个eGFR方程计算，包括慢性肾脏疾病流行病学协作（CKD-EPI），有和没有种族调整。泊松回归用于调查基线eGFR与国际腹水俱乐部标准AKI事件之间的关系。我们确定了72,267例肝硬化患者，其中97.3%为男性，57.8%为白人，19.7%为黑人。在调整后的模型中，中位随访2.78年（四分位数范围1.22-5.16），CKD-EPI导致的较低基线eGFR与较高的AKI发生率显著相关。对于所有方程式，当种族调整被移除时，这种关联受到的影响最小。例如，从CKD-EPI中去除种族调整导致每15mL/min/1.73m2变化中较低eGFR和较高AKI事件发生率之间的相关性增加0.1% （p<0.001）。eGFR方程中的种族调整并未增强肝硬化患者AKI的风险估计。需要进一步的研究来评估从eGFR方程中去除种族对临床结果和政策的影响。
Accuracy of glomerular filtration rate estimating (eGFR) equations has significant implications in cirrhosis, potentially guiding simultaneous liver kidney allocation and drug dosing. Most equations adjust for Black race, partially accounted for by reported differences in muscle mass by race. Patients with cirrhosis, however, are prone to sarcopenia which may mitigate such differences. We evaluated the association between baseline eGFR and incident acute kidney injury (AKI) in patients with cirrhosis with and without race adjustment. We conducted a retrospective national cohort study of veterans with cirrhosis. Baseline eGFR was calculated using multiple eGFR equations including Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), both with and without race adjustment. Poisson regression was used to investigate the association between baseline eGFR and incident AKI events per International Club of Ascites criteria. We identified 72,267 patients with cirrhosis, who were 97.3% male, 57.8% white, and 19.7% Black. Over median follow-up 2.78 years (interquartile range 1.22-5.16), lower baseline eGFR by CKD-EPI was significantly associated with higher rates of AKI in adjusted models. For all equations this association was minimally impacted when race adjustment was removed. For example, removal of race adjustment from CKD-EPI resulted in a 0.1% increase in the association between lower eGFR and higher rate of AKI events per 15mL/min/1.73m2 change (p<0.001). Race adjustment in eGFR equations did not enhance AKI risk estimation in patients with cirrhosis. Further study is warranted to assess the impacts of removing race from eGFR equations on clinical outcomes and policy.
登录
查看更多内容
DOI：
10.1002/lt.24750
发表时间：
2017-05
期刊：
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
影响因子：
--
作者：
Carey EJ;Lai JC;Wang CW;Dasarathy S;Lobach I;Montano-Loza AJ;Dunn MA;Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium
通讯作者：
Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium
2001-2013 年美国退伍军人肝硬化和肝细胞癌负担趋势（按肝脏疾病分类
影响因子：
29.4
作者：
Beste, Lauren A.;Leipertz, Steven L.;Ioannou, George N.
通讯作者：
Ioannou, George N.
影响因子：
13.5
作者：
Mindikoglu, Ayse L.;Dowling, Thomas C.;Weir, Matthew R.;Seliger, Stephen L.;Christenson, Robert H.;Magder, Laurence S.
通讯作者：
Magder, Laurence S.
影响因子：
4.1
作者：
Sohn, Won;Kim, Jung Hee;Cho, Ju-Yeon
通讯作者：
Cho, Ju-Yeon
影响因子：
3.3
作者：
Gallagher, D;Visser, M;Heymsfield, SB
通讯作者：
Heymsfield, SB