New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
04 11 2021
04 11 2021
Historique:
pubmed:
24
9
2021
medline:
20
11
2021
entrez:
23
9
2021
Statut:
ppublish
Résumé
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 m 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.).
Sections du résumé
BACKGROUND
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.
METHODS
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.
RESULTS
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 m
CONCLUSIONS
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.).
Identifiants
pubmed: 34554658
doi: 10.1056/NEJMoa2102953
pmc: PMC8822996
mid: NIHMS1763303
doi:
Substances chimiques
CST3 protein, human
0
Cystatin C
0
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1737-1749Subventions
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Investigateurs
Margret B Andresdottir
(MB)
Hrefna Gudmundsdottir
(H)
Olafur S Indridason
(OS)
Runolfur Palsson
(R)
Bertram Kasiske
(B)
Matthew Weir
(M)
Todd Pesavento
(T)
Roberto Kalil
(R)
Harold Feldman
(H)
Amanda Anderson
(A)
Alan Go
(A)
Chi-Yuan Hsu
(CY)
Arlene B Chapman
(AB)
Douglas P Landsittel
(DP)
Michal Mrug
(M)
Alan S L Yu
(ASL)
Michael Steffes
(M)
Barbara H Braffett
(BH)
Christina Wyatt
(C)
Zipporah Krishnasami
(Z)
James Hellinger
(J)
Alison Abraham
(A)
John C Lieske
(JC)
Tariq Shafi
(T)
Wendy Post
(W)
Peter Rossing
(P)
Jerome Rossert
(J)
Benedicte Stengel
(B)
Andrzej Galecki
(A)
Catherine Spino
(C)
Michael Mauer
(M)
Amy Karger
(A)
Bernard Zinman
(B)
Ronald Klein
(R)
Hans-Henrik Parving
(HH)
Helen C Looker
(HC)
William C Knowler
(WC)
Goran B Klintmalm
(GB)
Ruben Velez
(R)
Elizabeth Selvin
(E)
Dan Wang
(D)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2021 Massachusetts Medical Society.
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