Is race adjustment necessary to estimate glomerular filtration rate in South Brazilians?

Autor: Escott GM; Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2º andar, Porto Alegre, RS, 90035-003, Brazil. gustavo.escott@gmail.com.; Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. gustavo.escott@gmail.com., Zingano CP; Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2º andar, Porto Alegre, RS, 90035-003, Brazil.; Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., Ferlin E; Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., Garroni M; Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2º andar, Porto Alegre, RS, 90035-003, Brazil.; Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., Thomé FS; Nephrology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., Veronese FJV; Nephrology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., Silveiro SP; Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2º andar, Porto Alegre, RS, 90035-003, Brazil.; Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.; Endocrine Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Jazyk: angličtina
Zdroj: Journal of nephrology [J Nephrol] 2024 Dec; Vol. 37 (9), pp. 2635-2645. Date of Electronic Publication: 2024 Jun 24.
DOI: 10.1007/s40620-024-02001-x
Abstrakt: Background and Aims: Race coefficients (RC) in equations to estimate glomerular filtration rate (GFR) have been highly questioned. We aimed to evaluate the performance of three equations, namely 2009 Chronic Kidney Disease Epidemiology Collaboration (2009 CKD-EPI), 2021 CKD-EPI, and European Kidney Function Consortium (EKFC) in self-reported Black and White Brazilians.
Materials and Methods: Our cross-sectional study compared estimated GFR (eGFR) with 51 Cr-EDTA measured GFR (mGFR) in healthy adults, patients with type 2 diabetes mellitus with or without chronic kidney disease (CKD), and in non-diabetic individuals with CKD. The performance of these equations was assessed using Bland-Altman plots, Lin's concordance correlation coefficient (CCC), bias, P30, and P15 accuracy.
Results: Three hundred six White adults (aged 53 ± 17 years, 55% women, mean mGFR: 83 ± 32 mL/min/1.73 m 2 ) and 48 Black participants (aged 53 ± 17 years, 58% women, mGFR: 90 ± 34 mL/min/1.73 m 2 ) were included. No equation achieved the desirable P30 accuracy value of 90%, neither in White (2009 CKD-EPI:78%, 2021 CKD-EPI:76% and EKFC:77%, p = 0.368) nor in Black volunteers (respective values of 77%, 75%, and 77%; p = 0.882). The 2009 CKD-EPI showed the best performance in Black participants (bias: 4.04; CCC: 0.848), whereas the 2021 CKD-EPI performed better in Whites, with smaller bias (1.45), and better concordance correlation coefficient (0.790). The EKFC presented the worst performance. All equations underdiagnosed advanced CKD in White participants, but not in Black.
Conclusions: The 2021 CKD-EPI does not outperform the 2009 CKD-EPI. Instead, it underestimated the occurrence of CKD in White participants. Thus, we do not recommend replacing the 2009 with the new 2021 CKD-EPI in the Brazilian population.
Competing Interests: Declarations. Conflict of interest: All authors declare no competing interests. Ethical approval: The study was approved by the Research Ethics Committee of Hospital de Clínicas de Porto Alegre (number 20160153). All enrolled participants signed the informed consent form in accordance with the Helsinki declaration. Statement of human rights: All procedures were approved by the Research Ethics Committee of HCPA (number 20160153). Informed consent: All participants provided informed consent prior to their participation.
(© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.)
Databáze: MEDLINE
Externí odkaz: