Department of Nephrology, Dialysis, Hypertension and Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium.
Clin J Am Soc Nephrol. 2011 Apr;6(4):906-12. doi: 10.2215/CJN.10931210. Epub 2011 Mar 24.
Regarding the high prevalence of African American patients with ESRD, it is important to estimate the prevalence of early stages of chronic kidney disease in this specific population. Because serum creatinine concentration is dependent on muscular mass, an ethnic factor has to be applied to creatinine-based equations. Such ethnic factors have been proposed in the Modification of Diet in Renal Disease (MDRD) study equation and in the more recent Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. This review analyzes how these correction factors have been developed and how they have, or have not, been validated in external populations. It will be demonstrated that the African American factor in the MDRD study equation is accurate in African American chronic kidney disease (CKD) patients. However, it will be shown that this factor is probably too high for subjects with a GFR of ≥60 ml/min per 1.73 m(2), leading to an underestimation of the prevalence of CKD in the global African American population. It will also be confirmed that this ethnic factor is not accurate in African (non-American) subjects. Lastly, the lack of true external validation of the new CKD-EPI equations will be discussed. Additional trials seem necessary in American African and African populations to better estimate GFR and apprehend the true prevalence of CKD in this population with a high renal risk.
关于非裔美国人终末期肾病的高发率，重要的是要估计这一特定人群慢性肾脏病早期阶段的流行率。因为血清肌酐浓度取决于肌肉质量，所以必须在基于肌酐的公式中应用种族因素。这些种族因素已经在肾脏病饮食改良研究（MDRD）方程和最近的慢性肾脏病流行病学协作组（CKD-EPI）方程中提出。这篇综述分析了这些校正因子是如何发展的，以及它们在外部人群中是否得到了验证。结果表明，MDRD 研究方程中的非裔美国人校正因子在非裔美国人慢性肾脏病（CKD）患者中是准确的。然而，结果表明，对于肾小球滤过率（GFR）≥60 ml/min/1.73 m²的患者，该因子可能过高，导致全球非裔美国人 CKD 的流行率被低估。也将证实该种族因子在非裔（非美国）人群中并不准确。最后，将讨论新的 CKD-EPI 方程缺乏真正的外部验证。似乎需要在美国非裔和非洲人群中进行更多的试验，以更好地估计 GFR，并了解这一具有高肾脏风险人群中 CKD 的真实流行率。
