Ibrahim Hassan N, Wang Changchun, Ishani Areef, Collins Allan J, Foley Robert N
Department of Medicine, University of Minnesota, USA.
Clin J Am Soc Nephrol. 2008 Nov;3(6):1792-9. doi: 10.2215/CJN.01890408. Epub 2008 Sep 10.
An ideal and effective screening tool should perform equally across ethnic groups. The objective of this study was to determine whether the widely advocated creatinine-based estimated GFR (eGFR) threshold of 60 ml/min per 1.73 m(2) identifies the typical metabolic abnormalities related to chronic kidney disease equally well in minority and nonminority adults.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This objective was addressed using data for 8918 minority and nonminority adult participants in the National Health and Nutrition Examination Survey 2003 through 2006, which used stratified, multistage, probability sampling methods to assemble a nationwide probability sample of the noninstitutionalized population of the United States. Metabolic abnormalities including BP, potassium, hemoglobin, bicarbonate, uric acid, calcium, phosphorus, and parathyroid hormone were defined by fifth or 95th percentile values.
Among participants with eGFR <60 ml/min per 1.73 m(2), black individuals were more likely than white individuals to have low hemoglobin (adjusted odds ratio [aOR] 3.76; 95% confidence interval [CI] 1.94 to 7.28), elevated uric acid (aOR 2.15; 95% CI 1.26 to 3.68), and elevated parathyroid hormone (aOR 3.93; 95% CI 2.33 to 6.66).
Metabolic consequences of reduced eGFR are more common in black individuals and seem to be present at levels well above 60 ml/min per 1.73 m(2); thus, black individuals should be screened for the metabolic complications of chronic kidney at higher GFR levels.
一种理想且有效的筛查工具应在不同种族群体中表现一致。本研究的目的是确定广泛倡导的基于肌酐的估算肾小球滤过率（eGFR）阈值60ml/（min·1.73m²）在少数族裔和非少数族裔成年人中识别与慢性肾脏病相关的典型代谢异常的效果是否相同。
设计、地点、参与者与测量：通过2003年至2006年美国国家健康与营养检查调查中8918名少数族裔和非少数族裔成年参与者的数据来实现这一目标，该调查采用分层、多阶段概率抽样方法，对美国非机构化人口进行全国范围的概率抽样。代谢异常包括血压、血钾、血红蛋白、碳酸氢根、尿酸、血钙、血磷和甲状旁腺激素，通过第五或第95百分位数来定义。
在eGFR<60ml/（min·1.73m²）的参与者中，黑人比白人更易出现血红蛋白降低（校正比值比[aOR]3.76；95%置信区间[CI]1.94至7.28）、尿酸升高（aOR2.15；95%CI1.26至3.68）和甲状旁腺激素升高（aOR3.93；95%CI2.33至6.66）。
eGFR降低的代谢后果在黑人个体中更为常见，且似乎在远高于60ml/（min·1.73m²）的水平就已出现；因此，应在更高的GFR水平对黑人个体进行慢性肾脏病代谢并发症的筛查。
