Nguyen Minhtri K, Bandaru Dhiresh
Medicine, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA.
Cureus. 2025 Mar 11;17(3):e80441. doi: 10.7759/cureus.80441. eCollection 2025 Mar.
Assessment of glomerular filtration rate (GFR) is commonly based on serum creatinine levels. It is well-established that, for a given GFR, the mean serum creatinine level is higher in Black individuals than in non-Black individuals. Failure to account for this difference in creatinine-based GFR estimation equations leads to inaccuracies in GFR estimates for Black individuals. This higher mean serum creatinine level in Black individuals has been attributed to greater muscle mass, though this explanation remains debated. In this article, we provide mathematical proof showing that the higher mean serum creatinine level in Black individuals reflects the "net" creatinine generation rate after accounting for renal tubular secretion of creatinine and extrarenal creatinine elimination. To accurately estimate GFR, this "net" creatinine generation rate must be considered. By rescaling serum creatinine to account for the differences in creatinine production rates between Black and non-Black populations, the population-specific creatinine-based European Kidney Function Consortium (EKFC) equation provides a more accurate GFR estimate than the current Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI 2021) equation.
肾小球滤过率（GFR）的评估通常基于血清肌酐水平。众所周知，对于给定的GFR，黑人个体的平均血清肌酐水平高于非黑人个体。在基于肌酐的GFR估算方程中未能考虑这种差异会导致黑人个体GFR估算不准确。黑人个体中这种较高的平均血清肌酐水平归因于更大的肌肉量，不过这一解释仍存在争议。在本文中，我们提供数学证明表明，黑人个体中较高的平均血清肌酐水平反映了在考虑肌酐肾小管分泌和肾外肌酐清除后的“净”肌酐生成率。为了准确估算GFR，必须考虑这种“净”肌酐生成率。通过重新调整血清肌酐以考虑黑人和非黑人人群之间肌酐生成率的差异，基于人群特异性肌酐的欧洲肾功能联盟（EKFC）方程比当前的慢性肾脏病流行病学协作组（CKD-EPI 2021）方程能提供更准确的GFR估算。
