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Lesley A. Inker, Nwamaka D. Eneanya, Josef Coresh, Hocine Tighiouart, Dan Wang, Yingying Sang, Deidra C. Crews, Alessandro Doria, Michelle M. Estrella, Marc Froissart and 23 more
BACKGROUNDCurrent 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. METHODSWe 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. RESULTSIn 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 2 of body-surface area; 95% confidence interval [CI], 1.8 to 5.4) and to a lesser degree in non-Blacks (median, 0.5 ml per minute per 1.73 m 2 ; 95% CI, 0.0 to 0.9).When the adjustment for Black race was omitted from the current eGFR equation, measured GFR in Blacks was underestimated (median, 7.1 ml per minute per 1.73 m 2 ; 95% CI, 5.9 to 8.8).A new equation using age and sex and omitting race underestimated measured GFR in Blacks (median, 3.6 ml per minute per 1.73 m 2 ; 95% CI, 1.8 to 5.5) and overestimated measured GFR in non-Blacks (median, 3.9 ml per minute per 1.73 m 2 ; 95% CI, 3.4 to 4.4).For all equations, 85% or more of the eGFRs for Blacks and non-Blacks were within 30% of measured GFR.New creatinine-cystatin C equations without race were more accurate than new creatinine equations, with smaller differences between race groups.As compared with the current creatinine equation, the new creatinine equations, but not the new creatinine-cystatin C equations, increased population estimates of CKD prevalence among Blacks and yielded similar or lower prevalence among non-Blacks. CONCLUSIONSNew 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.
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Inker, L. A., Eneanya, N. D., Coresh, J., Tighiouart, H., Wang, D., Sang, Y., Crews, D. C., Doria, A., Estrella, M. M., Froissart, M., Grams, M. E., Greene, T., GRUBB, A. O., Gudnason, V. G., Gutiérrez, O. M., Kalil, R., Karger, A. B., Mauer, M., Navis, G., … Levey, A. S. (2021). New Creatinine- and Cystatin C–Based Equations to Estimate GFR without Race. New England Journal of Medicine, 385(19), 1737–1749. https://doi.org/10.1056/nejmoa2102953
Inker, Lesley A., et al. "New Creatinine- and Cystatin C–Based Equations to Estimate GFR without Race." New England Journal of Medicine, vol. 385, no. 19, 2021, pp. 1737–1749, https://doi.org/10.1056/nejmoa2102953.
Inker, Lesley A., Nwamaka D. Eneanya, Josef Coresh, Hocine Tighiouart, Dan Wang, Yingying Sang, Deidra C. Crews, et al. "New Creatinine- and Cystatin C–Based Equations to Estimate GFR without Race." New England Journal of Medicine 385, no. 19 (2021): 1737–1749. https://doi.org/10.1056/nejmoa2102953.
Inker L. A., Eneanya N. D., Coresh J. [и др.] New Creatinine- and Cystatin C–Based Equations to Estimate GFR without Race // New England Journal of Medicine. — 2021. — Vol. 385, № 19. — P. 1737–1749. — URL: https://doi.org/10.1056/nejmoa2102953
@article{inker2021creatinine,
title = {{New Creatinine- and Cystatin C–Based Equations to Estimate GFR without Race}},
author = {Lesley A. Inker and Nwamaka D. Eneanya and Josef Coresh and Hocine Tighiouart and Dan Wang and Yingying Sang and Deidra C. Crews and Alessandro Doria and Michelle M. Estrella and Marc Froissart and Morgan E. Grams and Tom Greene and ANDERS O. GRUBB and Vilmundur G. Gudnason and Orlando M. Gutiérrez and Roberto Kalil and Amy B. Karger and Michael Mauer and Gerjan Navis and Robert G. Nelson and Emilio D. Poggio and Roger Rodby and Peter Rossing and Andrew D. Rule and Elizabeth Selvin and Jesse C. Seegmiller and Michael G. Shlipak and Vicente E. Torres and Wei Yang and Shoshana H. Ballew and Sara J. Couture and Neil R. Powe and Andrew S. Levey},
journal = {New England Journal of Medicine},
year = {2021},
volume = {385},
number = {19},
pages = {1737--1749},
doi = {10.1056/nejmoa2102953},
url = {https://doi.org/10.1056/nejmoa2102953}
}TY - JOUR AU - Inker, Lesley A. AU - Eneanya, Nwamaka D. AU - Coresh, Josef AU - Tighiouart, Hocine AU - Wang, Dan AU - Sang, Yingying AU - Crews, Deidra C. AU - Doria, Alessandro AU - Estrella, Michelle M. AU - Froissart, Marc AU - Grams, Morgan E. AU - Greene, Tom AU - GRUBB, ANDERS O. AU - Gudnason, Vilmundur G. AU - Gutiérrez, Orlando M. AU - Kalil, Roberto AU - Karger, Amy B. AU - Mauer, Michael AU - Navis, Gerjan AU - Nelson, Robert G. AU - Poggio, Emilio D. AU - Rodby, Roger AU - Rossing, Peter AU - Rule, Andrew D. AU - Selvin, Elizabeth AU - Seegmiller, Jesse C. AU - Shlipak, Michael G. AU - Torres, Vicente E. AU - Yang, Wei AU - Ballew, Shoshana H. AU - Couture, Sara J. AU - Powe, Neil R. AU - Levey, Andrew S. TI - New Creatinine- and Cystatin C–Based Equations to Estimate GFR without Race JO - New England Journal of Medicine VL - 385 IS - 19 SP - 1737 EP - 1749 PY - 2021 DA - 2021/09/23 DO - 10.1056/nejmoa2102953 UR - https://doi.org/10.1056/nejmoa2102953 ER -
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