Evaluation of race-free eGFR equations in individuals of different ethnicity.

IF 2.3 4区医学

Blood Pressure Pub Date : 2025-12-01 Epub Date: 2025-07-22 DOI:10.1080/08037051.2025.2533456

De-Wei An, Gontse G Mokwatsi, Dong-Yan Zhang, Dries S Martens, Yu-Ling Yu, Babangida S Chori, Augustine N Odili, Ruan Kruger, Lebo F Gafane-Matemane, Justyna Siwy, Agnieszka Latosinska, Harald Mischak, Catharina Mc Mels, Aletta E Schutte, Jean-René M'Buyamba-Kabangu, Tim S Nawrot, Yan Li, Jan A Staessen

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引用次数: 0

Abstract

Background: Glomerular filtration rate (eGFR) derived from serum creatinine (eGFR_cr), cystatin C (eGFR_cys), or both (eGFR_cr-cys) by race-free equations are recommended staging chronic kidney disease (CKD). The current study aimed to compare these race-free eGFR equations for screening for low-grade CKD in Blacks and non-Blacks and to evaluate their association with mortality.

Methods: Race-free eGFR equations were evaluated in four studies with specific inclusion criteria based on the original research goals: African-PREDICT (341/380 healthy Black/White South Africans), FLEMENGHO (709 White community-dwelling Flemish), NHANES (1760/7931 Black and non-Black adult Americans), and 401 Black African patients hospitalised in Mbuji Mayi, Democratic Republic of Congo. The intraclass correlation coefficient and Bland and Altman statistics were used to assess consistency between eGFR equations and multivariable logistic or Cox regression to evaluate their association with mortality.

Results: Intraindividual discordance between eGFRs was larger in Black than non-Black NHANES and African-PREDICT participants. In NHANES, eGFR_cr-cys was greater than eGFR_cr, but smaller than eGFR_cys, and replacing eGFR_cr-cys by eGFR_cr moved 25% Blacks and 15% non-Blacks to a higher (worse) eGFR KDIGO stage. In African-PREDICT and FLEMENGO, half of the measured creatinine clearance to eGFR ratios fell outside the expected 1.1-1.2 band. In NHANES, multivariable hazard ratios for total and cardiovascular mortality in relation to CKD grade were all lower than unity for grade-1 CKD and greater than unity for grade ≥3 (p < 0.0001) without any racial difference (0.11≤p ≤ 0.98). These NHANES findings were consistent, if CKD stage was replaced by eGFR and in subgroup analyses. Whereas eGFR_cys and eGFR_cr-cys refined models, eGFR_cr did not.

Conclusions: The NHANES mortality outcomes support the use of eGFR_cys and eGFR_cr-cys. However, large intraindividual variability between eGFR estimates may lead to KDIGO eGFR stage misclassification and calls for caution in the opportunistic or systematic screening for CKD in asymptomatic individuals with prevention as objective.

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不同种族个体中无种族eGFR方程的评价。

背景：肾小球滤过率（eGFR）由血清肌酐（eGFRcr）、胱抑素C （eGFRcys）或两者（eGFRcr-cys）通过无种族方程得出，推荐用于慢性肾脏疾病（CKD）分期。目前的研究旨在比较这些无种族的eGFR方程用于筛查黑人和非黑人的低级别CKD，并评估其与死亡率的关系。方法：根据最初的研究目标，在四项研究中评估无种族的eGFR方程，并制定具体的纳入标准：African- predict（341/380名健康的南非黑人/白人）、FLEMENGHO（709名白人社区居住的佛兰芒人）、NHANES（1760/7931名黑人和非黑人成年美国人）和401名在刚果民主共和国Mbuji Mayi住院的非洲黑人患者。使用类内相关系数和Bland和Altman统计来评估eGFR方程与多变量逻辑回归或Cox回归之间的一致性，以评估其与死亡率的相关性。结果：黑人受试者的egfr个体内差异大于非黑人NHANES和非洲裔predict受试者。在NHANES中，eGFRcr-cys大于eGFRcr，但小于eGFRcys，用eGFRcr代替eGFRcr-cys使25%的黑人和15%的非黑人进入eGFR更高（更差）的KDIGO阶段。在African-PREDICT和FLEMENGO，一半的肌酐清除率与eGFR比值低于预期的1.1-1.2范围。在NHANES中，与CKD分级相关的总死亡率和心血管死亡率的多变量风险比在1级CKD中均小于1，在≥3级CKD中大于1 （p cys和eGFRcr-cys精细模型，eGFRcr没有）。结论：NHANES死亡率结果支持eGFRcys和eGFRcr-cys的使用。然而，eGFR估计值之间的巨大个体差异可能导致KDIGO对eGFR分期的错误分类，并呼吁在无症状个体中以预防为目标的CKD机会性或系统性筛查时要谨慎。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Pressure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

3.20

自引率

5.60%

发文量

期刊介绍： For outstanding coverage of the latest advances in hypertension research, turn to Blood Pressure, a primary source for authoritative and timely information on all aspects of hypertension research and management. Features include: • Physiology and pathophysiology of blood pressure regulation • Primary and secondary hypertension • Cerebrovascular and cardiovascular complications of hypertension • Detection, treatment and follow-up of hypertension • Non pharmacological and pharmacological management • Large outcome trials in hypertension.