当前慢性肾脏疾病筛查标准在不同种族男女中的表现：HELIUS研究

Mayo Clinic proceedings. Innovations, quality & outcomes Pub Date : 2025-04-17 DOI:10.1016/j.mayocpiqo.2025.100613

Taryn G. Vosters MSc , Vianda S. Stel PhD , Kitty J. Jager MD, PhD , Bart Ferwerda PhD , Roos F. Marsman MD, PhD , Frans J. van Ittersum MD, PhD , Bert-Jan H. van den Born MD, PhD , Henrike Galenkamp PhD , Liffert Vogt MD, PhD , Irene G.M. van Valkengoed PhD

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摘要

目的调查目前推荐的肾脏疾病：改善全球结局2024指南（高血压、糖尿病和心血管疾病）筛查标准是否能平等地检测不同种族的女性和男性，以及考虑指南中列出的可选标准（教育水平、职业、肥胖和遗传风险因素）是否能提高筛查效果。患者和方法我们纳入了来自基线HELIUS研究（2011年1月1日至2015年12月31日，荷兰阿姆斯特丹）的12384名女性和9046名男性，他们来自荷兰、南亚和非洲苏里南人、加纳人、土耳其人和摩洛哥人。慢性肾脏疾病（CKD）定义为肾小球滤过率估计为60ml /min/1.73 m2或白蛋白与肌酐比值为3mg /mmol。泊松回归分析估计了CKD与当前筛查标准之上的可选标准之间的关联。用似然比检验和赤池信息准则估计对男女进行模型比较。曲线下面积（AUC）、敏感性、特异性、阳性和阴性预测值按性别和种族计算。结果慢性肾病女性患病率为2.9% ~ 8.8%，男性患病率为3.2% ~ 8.6%。低教育水平（仅限女性）和肥胖显著改善了目前CKD标准的模型。高危职业和多基因风险评分对模型没有改善作用。然而，这些标准并没有改善跨种族的预测措施。总的来说，目前筛查标准的AUC在男性中是可以接受的(AUC, 0.75；95% CI, 0.73-0.77)，女性较差(AUC, 0.65；95% CI, 0.63-0.67)，添加可选标准后变化最小。结论目前的筛查标准可能不能平等地检测不同种族的女性和男性CKD。可选标准的附加价值有限。

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Performance of Current Chronic Kidney Disease Screening Criteria in Women and Men Across Ethnic Groups: The HELIUS Study

Objective

To investigate whether the currently recommended screening criteria in Kidney Disease: Improving Global Outcomes 2024 guidelines (hypertension, diabetes mellitus, and cardiovascular disease) equally detect women and men across ethnic groups and whether consideration of optional criteria (education level, occupation, obesity, and genetic risk factors) listed in the guideline improves performance.

Patients and Methods

We included 12,384 women and 9046 men of Dutch, South Asian and African Surinamese, Ghanaian, Turkish, and Moroccan origin from the baseline HELIUS Study (January 1, 2011, through December 31, 2015, Amsterdam, the Netherlands). Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m² or albumin-to-creatinine ratio of >3 mg/mmol. Poisson regression analyses estimated associations between CKD and optional criteria on top of current screening criteria. Model comparisons were made with likelihood ratio tests and Akaike information criterion estimations in women and men. Area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values were calculated by sex and ethnicity.

Results

Chronic kidney disease prevalence ranged from 2.9% to 8.8% in women and 3.2% to 8.6% in men. Low educational level (women only) and obesity significantly improved the models with current criteria with CKD. High-risk occupations and polygenic risk score did not improve the model. However, these criteria did not improve predictive measures across ethnic groups. Overall, the AUCs for the current screening criteria were acceptable in men (AUC, 0.75; 95% CI, 0.73-0.77) and poor in women (AUC, 0.65; 95% CI, 0.63-0.67), and showed minimal change after adding the optional criteria.

Conclusion

Current screening criteria may not be equally detecting women and men across ethnic groups with CKD. Optional criteria had limited added value.

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来源期刊

Mayo Clinic proceedings. Innovations, quality & outcomes Surgery, Critical Care and Intensive Care Medicine, Public Health and Health Policy

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49 days