Mahmud Nadim, Asrani Sumeet K, Reese Peter P, Kaplan David E, Taddei Tamar H, Nadim Mitra K, Serper Marina
Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, 4th Floor, South Pavilion, Philadelphia, PA, 19104, USA.
Gastroenterology Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
Dig Dis Sci. 2022 Apr;67(4):1399-1408. doi: 10.1007/s10620-021-06943-1. Epub 2021 Mar 24.
Accuracy of glomerular filtration rate estimating (eGFR) equations has significant implications in cirrhosis, potentially guiding simultaneous liver kidney allocation and drug dosing. Most equations adjust for Black race, partially accounted for by reported differences in muscle mass by race. Patients with cirrhosis, however, are prone to sarcopenia which may mitigate such differences. We evaluated the association between baseline eGFR and incident acute kidney injury (AKI) in patients with cirrhosis with and without race adjustment.
We conducted a retrospective national cohort study of veterans with cirrhosis. Baseline eGFR was calculated using multiple eGFR equations including Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), both with and without race adjustment. Poisson regression was used to investigate the association between baseline eGFR and incident AKI events per International Club of Ascites criteria.
We identified 72,267 patients with cirrhosis, who were 97.3% male, 57.8% white, and 19.7% Black. Over median follow-up 2.78 years (interquartile range 1.22-5.16), lower baseline eGFR by CKD-EPI was significantly associated with higher rates of AKI in adjusted models. For all equations this association was minimally impacted when race adjustment was removed. For example, removal of race adjustment from CKD-EPI resulted in a 0.1% increase in the association between lower eGFR and higher rate of AKI events per 15 mL/min/1.73 m change (p < 0.001).
Race adjustment in eGFR equations did not enhance AKI risk estimation in patients with cirrhosis. Further study is warranted to assess the impacts of removing race from eGFR equations on clinical outcomes and policy.
肾小球滤过率估算（eGFR）方程的准确性在肝硬化中具有重要意义，可能指导肝肾联合分配和药物剂量调整。大多数方程对黑人种族进行了校正，部分原因是不同种族报告的肌肉量存在差异。然而，肝硬化患者容易出现肌肉减少症，这可能会减轻这种差异。我们评估了在有和没有种族校正的肝硬化患者中，基线eGFR与急性肾损伤（AKI）发生率之间的关联。
我们对患有肝硬化的退伍军人进行了一项全国性回顾性队列研究。使用包括慢性肾脏病流行病学协作组（CKD-EPI）方程在内的多个eGFR方程计算基线eGFR，均有和没有种族校正。采用泊松回归分析根据国际腹水俱乐部标准评估基线eGFR与AKI发生事件之间的关联。
我们纳入了72267例肝硬化患者，其中男性占97.3%，白人占57.8%，黑人占19.7%。中位随访2.78年（四分位间距1.22 - 5.16），在调整模型中，CKD-EPI计算的较低基线eGFR与较高的AKI发生率显著相关。对于所有方程，去除种族校正后这种关联受到的影响最小。例如，从CKD-EPI方程中去除种族校正后，每15 mL/min/1.73m变化中，较低eGFR与较高AKI事件发生率之间的关联增加了0.1%（p < 0.001）。
eGFR方程中的种族校正并未增强对肝硬化患者AKI风险的估计。有必要进一步研究评估从eGFR方程中去除种族因素对临床结局和政策的影响。
