CKD-EPI 2021 方程和其他基于肌酐的种族独立 eGFR 方程在慢性肾脏病诊断和分期中的应用。
The CKD-EPI 2021 Equation and Other Creatinine-Based Race-Independent eGFR Equations in Chronic Kidney Disease Diagnosis and Staging.
机构信息
Department of Pathology and Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA, United States.
出版信息
J Appl Lab Med. 2023 Sep 7;8(5):952-961. doi: 10.1093/jalm/jfad047.
BACKGROUND
Recent debate on the race correction factor in creatinine-based estimated glomerular filtration rate (eGFR) has led to the development of a new race-independent equation (Chronic Kidney Disease Epidemiology Collaboration, CKD-EPI_2021). Previously, some institutions have already modified the early version of the CKD-EPI or Modification of Diet in Renal Disease (MDRD) equations by removing the race factors (CKD-EPI_2009_non-Black (NB), MDRD_NB) for Black populations although this approach remains controversial.
METHODS
In this study, the CKD-EPI_2009_NB, MDRD_NB, and European Kidney Function Consortium (EKFC) equations were compared directly with the CKD-EPI_2021 equation in eGFR calculation, chronic kidney disease (CKD) diagnosis, and staging in a local population.
RESULTS
These 3 previous methods underestimated eGFR compared to CKD-EPI_2021 for eGFR < 90 mL/min/1.73 m2 but overestimated eGFR at the high end (>120 mL/min/1.73 m2). Around the CKD diagnosis cutoff (60 mL/min/1.73 m2), both MDRD_NB and EFKC equations resulted in an increase in CKD cases compared to CKD-EPI_2021. CKD-EPI_2009_NB demonstrated a similar trend although the difference was not statistically significant. In a population with low eGFR (<60 mL/min/1.73 m2), the EKFC equation showed a CKD staging pattern significantly different from that by CKD-EPI_2021, but all 3 previous methods resulted in a similar number of end-stage renal failure cases. In general, the EKFC equation demonstrated a weaker agreement in eGFR calculation and concordance in classification with the CKD-EPI_2021 equation than MDRD_NB and CKD-EPI_2009_NB.
CONCLUSIONS
Our study provides a direct visual comparison to demonstrate the potential clinical impact between 3 previously used race-independent methods and the CKD-EPI_2021 equation and aids the communication with healthcare providers during the implementation of this new equation.
背景
最近关于基于肌酐的估算肾小球滤过率（eGFR）中的种族校正因子的争论导致了一种新的种族独立方程（慢性肾脏病流行病学合作组，CKD-EPI_2021）的发展。以前，一些机构已经通过去除黑人种族因素（CKD-EPI_2009_non-Black（NB），MDRD_NB）来修改早期的 CKD-EPI 或肾脏病饮食改良（MDRD）方程，尽管这种方法仍然存在争议。
方法
在这项研究中，直接比较了 CKD-EPI_2009_NB、MDRD_NB 和欧洲肾脏功能联盟（EKFC）方程与 CKD-EPI_2021 方程在当地人群中的 eGFR 计算、慢性肾脏病（CKD）诊断和分期中的应用。
结果
这些之前的 3 种方法在 eGFR < 90 mL/min/1.73 m2 时低估了 eGFR，而在 eGFR 较高端（>120 mL/min/1.73 m2）时高估了 eGFR。在 CKD 诊断截止值（60 mL/min/1.73 m2）附近，与 CKD-EPI_2021 相比，MDRD_NB 和 EFKC 方程均导致 CKD 病例增加。尽管差异无统计学意义，但 CKD-EPI_2009_NB 也表现出类似的趋势。在 eGFR 较低的人群中（<60 mL/min/1.73 m2），EKFC 方程的 CKD 分期模式与 CKD-EPI_2021 明显不同，但所有 3 种之前的方法导致终末期肾衰竭病例数相似。一般来说，EKFC 方程在 eGFR 计算和与 CKD-EPI_2021 方程的分类一致性方面的一致性均弱于 MDRD_NB 和 CKD-EPI_2009_NB。
结论
本研究提供了直接的视觉比较，以展示 3 种以前使用的种族独立方法与 CKD-EPI_2021 方程之间的潜在临床影响，并在实施新方程时有助于与医疗保健提供者进行沟通。
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