Stehlé Thomas, Vidal-Petiot Emmanuelle, Flamant Martin, Delanaye Pierre
Université Paris Est Créteil, Inserm U955, Institut Mondor de recherche biomédicale (IMRB), 8, rue du Général Sarrail, 94010 Créteil cedex, France
Hôpitaux universitaires Henri Mondor, AP-HP, Service de néphrologie et transplantation, Fédération hospitalo-universitaire « Innovative therapy for immune disorders », 1, rue Gustave Eiffel, 94010 Créteil, France
Nephrol Ther. 2023 Mar 16;19(1):13-22. doi: 10.1684/ndt.2023.11.
Glomerular filtration rate (GFR) is estimated from equations based on serum or plasma concentrations of endogenous markers (creatinine and/or cystatin C), and demographic data (age, sex, ± ethnicity). These equations are accurate at the population level, but often inaccurate at the individual level. The creatinine-based Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation published in 2009 (CKD-EPIcr-2009), and the CKD-EPI equation published in 2012 based on creatinine and cystatin C, were recalibrated in 2021 to remove their dedicated race correction factors for black American subjects. All creatinine-based CKD-EPI equations overestimate true GFR in subjects younger than 30 years. The Full Age Spectrum (FAS) equation, applicable across the entire age spectrum (pediatrics to old age), solved this problem, but remained suboptimal at low GFR values. The European Kidney Function Consortium (EKFC) equation published in 2021 was an improvement of the FAS equation, which also includes the Q factor (median creatinine in the general population). EKFC is applicable across the age spectrum and is efficient at low and normal GFR values. The new creatinine-based CKD-EPI equation (CKD-EPIcr-2021) underestimates GFR in Black Americans and overestimates it in non-Black Americans. In European and African subjects, CKD-EPIcr-2021 overestimates true GFR and should not be adopted. The EKFC equation, which performs well in this population, also performs well in European Black subjects and in African subjects, provided dedicated Q factors are used.
肾小球滤过率（GFR）通过基于内源性标志物（肌酐和/或胱抑素C）的血清或血浆浓度以及人口统计学数据（年龄、性别、±种族）的公式来估算。这些公式在人群层面是准确的，但在个体层面往往不准确。2009年发布的基于肌酐的慢性肾脏病流行病学协作组（CKD-EPI）公式（CKD-EPIcr-2009）以及2012年发布的基于肌酐和胱抑素C的CKD-EPI公式在2021年进行了重新校准，以去除针对美国黑人受试者的专门种族校正因子。所有基于肌酐的CKD-EPI公式在30岁以下的受试者中都会高估真实的GFR。全年龄谱（FAS）公式适用于整个年龄范围（从儿科到老年），解决了这个问题，但在低GFR值时仍不理想。2021年发布的欧洲肾功能联盟（EKFC）公式是FAS公式的改进版，它还包括Q因子（一般人群中的肌酐中位数）。EKFC适用于整个年龄谱，在低GFR值和正常GFR值时都很有效。新的基于肌酐的CKD-EPI公式（CKD-EPIcr-2021）在非裔美国人中低估GFR，在非非裔美国人中高估GFR。在欧洲人和非洲人中，CKD-EPIcr-2021高估了真实的GFR，不应采用。在该人群中表现良好的EKFC公式，在欧洲黑人受试者和非洲受试者中也表现良好，前提是使用专门的Q因子。
