Miller W Greg, Kaufman Harvey W, Levey Andrew S, Straseski Joely A, Wilhelms Kelly W, Yu Hoi-Ying Elsie, Klutts J Stacey, Hilborne Lee H, Horowitz Gary L, Lieske John, Ennis Jennifer L, Bowling James L, Lewis Mary Jane, Montgomery Elizabeth, Vassalotti Joseph A, Inker Lesley A
Virginia Commonwealth University, Richmond, VA, USA.
Quest Diagnostics, Secaucus, NJ, USA.
Clin Chem. 2022 Mar 31;68(4):511-520. doi: 10.1093/clinchem/hvab278.
Recognizing that race is a social and not a biological construct, healthcare professionals and the public have called for removal of race in clinical algorithms. In response, the National Kidney Foundation and the American Society of Nephrology created the Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases to examine the issue and provide recommendations. The final report from the Task Force recommends calculating estimated glomerular filtration rate (eGFR) without a race coefficient using the recently published CKD-EPI 2021 creatinine (cr) and creatinine-cystatin C (cr-cys) equations. The Task Force recommends immediately replacing older eGFRcr equations (MDRD Study and CKD-EPI 2009) with the new CKD-EPI 2021 equation. In a 2019 survey by the College of American Pathologists, 23% of 6200 laboratories reporting eGFRcr used an incorrect equation that is not suitable for use with standardized creatinine measurements, 34% used the CKD-EPI 2009 equation and 43% used the MDRD Study 2006 equation re-expressed for standardized creatinine measurement. Rapid transition to using the CKD-EPI 2021 equation is an opportunity for laboratories to standardize to a single equation to eliminate differences in eGFRcr due to different equations used by different laboratories, and to report eGFR without use of race. We provide guidance to laboratories for implementing the CKD-EPI 2021 equations for both eGFRcr and eGFRcr-cys.
认识到种族是一种社会建构而非生物学概念，医疗保健专业人员和公众呼吁在临床算法中去除种族因素。对此，美国国家肾脏基金会和美国肾脏病学会成立了重新评估种族因素在肾脏疾病诊断中应用的特别工作组，以研究该问题并提供建议。特别工作组的最终报告建议使用最近发布的CKD-EPI 2021肌酐（cr）和肌酐-胱抑素C（cr-cys）方程来计算估算肾小球滤过率（eGFR），且不使用种族系数。特别工作组建议立即用新的CKD-EPI 2021方程取代旧的eGFRcr方程（MDRD研究方程和CKD-EPI 2009方程）。在美国病理学家学会2019年的一项调查中，报告eGFRcr的6200个实验室中有23%使用了不适用于标准化肌酐测量的错误方程，34%使用了CKD-EPI 2009方程，43%使用了针对标准化肌酐测量重新表述的2006年MDRD研究方程。迅速过渡到使用CKD-EPI 2021方程，对实验室来说是一个机会，可使其标准化为单一方程，以消除因不同实验室使用不同方程而导致的eGFRcr差异，并在不使用种族因素的情况下报告eGFR。我们为实验室提供了实施CKD-EPI 2021方程计算eGFRcr和eGFRcr-cys的指南。
