在巴西人群中估算肾小球滤过率时，CKD-EPI方程无需进行种族-民族校正。
No Race-Ethnicity Adjustment in CKD-EPI Equations Is Required for Estimating Glomerular Filtration Rate in the Brazilian Population.
作者信息
Rocha Amanda D, Garcia Suzane, Santos Andressa B, Eduardo José C C, Mesquita Claudio T, Lugon Jocemir R, Strogoff-de-Matos Jorge P
机构信息
Postgraduation Program in Medical Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil.
Postgraduation Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil.
出版信息
Int J Nephrol. 2020 Jul 18;2020:2141038. doi: 10.1155/2020/2141038. eCollection 2020.
BACKGROUND
Glomerular filtration rate (GFR) is usually estimated from equations using serum creatinine (sCr), with adjustment for gender, age, and race (black or nonblack). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) is the preferred equation for adults, but it was validated for the United States population. We intended to evaluate if the race-ethnicity adjustment proposed for the sCr-based CKD-EPI equations is appropriate for the Brazilian population.
METHODS
CKD outpatients had blood samples collected for determination of sCr and serum cystatin C (sCys) levels. GFR was measured (mGFR) by plasma clearance of Cr-EDTA and used as the reference. We compared values of mGFR and estimated GFR (eGFR) by CKD-EPI equations based on sCr (eGFR) and on the combination of sCr and sCys (eGFR). For African Brazilian patients, eGFR was calculated either without or with race adjustment. Accuracy was considered acceptable if the difference between the values of eGFR and mGFR was ≤30% (P30).
RESULTS
100 patients were enrolled (58 ± 14 years, 46% male, 39% white and 61% African Brazilian). Mean mGFR was 46.7 ± 29.2 ml/min/1.73 m. Mean eGFR and eGFR without race adjustment were 47.8 ± 30.1 ml/min/1.73 m and 46.4 ± 30.3 ml/min/1.73 m, respectively. The corresponding P30 accuracy values were 79.0% and 83.0%. In the African Brazilian subgroup, values for mean mGFR and eGFR either without or with race adjustment were 49.8 ± 32.2 ml/min/1.73 m, 50.4 ± 32.7 ml/min/1.73 m, and 58.4 ± 37.9 ml/min/1.73 m ( < 0.001 vs. mGFR), respectively. P30 accuracy values for eGFR either without or with race adjustment were 75.4% and 67.2%, respectively.
CONCLUSIONS
The use of CKD-EPI equations without race-ethnicity adjustment seems more appropriate for the Brazilian population.
背景
肾小球滤过率（GFR）通常通过使用血清肌酐（sCr）的方程进行估算，并根据性别、年龄和种族（黑人或非黑人）进行调整。慢性肾脏病流行病学协作组（CKD-EPI）方程是成人的首选方程，但它是在美国人群中验证的。我们旨在评估基于sCr的CKD-EPI方程中提出的种族调整对于巴西人群是否合适。
方法
收集慢性肾脏病门诊患者的血样以测定sCr和血清胱抑素C（sCys）水平。通过Cr-EDTA的血浆清除率测量GFR（mGFR）并将其用作参考。我们比较了基于sCr的CKD-EPI方程（eGFR）以及基于sCr和sCys组合的方程（eGFR）所估算的GFR（eGFR）与mGFR的值。对于非洲裔巴西患者，计算了不进行种族调整和进行种族调整的eGFR。如果eGFR和mGFR值之间的差异≤30%（P30），则认为准确性可接受。
结果
共纳入100例患者（年龄58±14岁，男性46%，白人39%，非洲裔巴西人61%）。平均mGFR为46.7±29.2 ml/min/1.73m²。未进行种族调整的平均eGFR和eGFR分别为47.8±30.1 ml/min/1.73m²和46.4±30.3 ml/min/1.73m²。相应的P30准确性值分别为79.0%和83.0%。在非洲裔巴西亚组中，不进行种族调整和进行种族调整的平均mGFR和eGFR值分别为49.8±32.2 ml/min/1.73m²、50.4±32.7 ml/min/1.73m²和58.4±37.9 ml/min/1.73m²（与mGFR相比，P<0.001）。不进行种族调整和进行种族调整的eGFR的P30准确性值分别为75.4%和67.2%。
结论
对于巴西人群，使用不进行种族调整的CKD-EPI方程似乎更为合适。
Zotero 插件