Systematic review of international studies evaluating MDRD and CKD-EPI estimated glomerular filtration rate (eGFR) equations in Black adults.

Autor: Umeukeje EM; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America.; Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, United States of America., Koonce TY; Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of America., Kusnoor SV; Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of America.; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America., Ulasi II; Renal Unit, Department of Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria., Kostelanetz S; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States of America., Williams AM; Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of America., Blasingame MN; Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of America., Epelbaum MI; Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of America., Giuse DA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America., Apple AN; Vanderbilt University School of Medicine, Nashville, TN, United States of America., Kaur K; Vanderbilt University School of Medicine, Nashville, TN, United States of America., González Peña T; Vanderbilt University School of Medicine, Nashville, TN, United States of America., Barry D; Department of Obstetrics & Gynecology, McGaw Medical Center of Northwestern University, Chicago, IL, United States of America., Eisenstein LG; Department of Medicine, NYU Langone Medical Center, New York, NY, United States of America., Nutt CT; Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States of America., Giuse NB; Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of America.; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America.; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Oct 18; Vol. 17 (10), pp. e0276252. Date of Electronic Publication: 2022 Oct 18 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0276252
Abstrakt: Use of race adjustment in estimating glomerular filtration rate (eGFR) has been challenged given concerns that it may negatively impact the clinical care of Black patients, as it results in Black patients being systematically assigned higher eGFR values than non-Black patients. We conducted a systematic review to assess how well eGFR, with and without race adjustment, estimates measured GFR (mGFR) in Black adults globally. A search across multiple databases for articles published from 1999 to May 2021 that compared eGFR to mGFR and reported outcomes by Black race was performed. We included studies that assessed eGFR using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICr) creatinine equations. Risk of study bias and applicability were assessed with the QUality Assessment of Diagnostic Accuracy Studies-2. Of 13,167 citations identified, 12 met the data synthesis criteria (unique patient cohorts in which eGFR was compared to mGFR with and without race adjustment). The studies included patients with and without kidney disease from Africa (n = 6), the United States (n = 3), Europe (n = 2), and Brazil (n = 1). Of 11 CKD-EPI equation studies, all assessed bias, 8 assessed accuracy, 6 assessed precision, and 5 assessed correlation/concordance. Of 7 MDRD equation studies, all assessed bias, 6 assessed accuracy, 5 assessed precision, and 3 assessed correlation/concordance. The majority of studies found that removal of race adjustment improved bias, accuracy, and precision of eGFR equations for Black adults. Risk of study bias was often unclear, but applicability concerns were low. Our systematic review supports the need for future studies to be conducted in diverse populations to assess the possibility of alternative approaches for estimating GFR. This study additionally provides systematic-level evidence for the American Society of Nephrology-National Kidney Foundation Task Force efforts to pursue other options for GFR estimation.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje