A New Panel-Estimated GFR, Including beta(2)-Microglobulin and beta-Trace Protein and Not Including Race, Developed in a Diverse Population

Autor: Joseph B. Margolick, Chi-yuan Hsu, Todd E. Pesavento, Bertram L. Kasiske, Vilmundur Gudnason, Andrew S. Levey, Runolfur Palsson, Hans-Henrik Parving, Matthew R. Weir, Lawrence A. Kingsley, Emilio D. Poggio, Sara J. Couture, Christina M. Wyatt, James Hellinger, Amy B. Karger, Peter Rossing, Steef J. Sinkeler, Margret B. Andresdottir, Alison G. Abraham, Tariq Shafi, Lesley A. Inker, Gerald J. Beck, Hrefna Gudmundsdottir, Hocine Tighiouart, Alessandro Doria, Roberto S. N. Kalil, Michael Mauer, Olafur S. Indridason, Jing M. Chen, Steven M. Wolinsky, Anna C. Porter, Tom Greene, Michael G. Shlipak, Gerjan Navis, Wendy S. Post, John H. Eckfeldt, Paul L. Kimmel, Jonathan J. Taliercio, Harold I. Feldman, Mallory D. Witt, Zipporah Krishnasami
Přispěvatelé: Value, Affordability and Sustainability (VALUE), Groningen Kidney Center (GKC)
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: American Journal of Kidney Diseases, 77(5), 673-683.e1. W B SAUNDERS CO-ELSEVIER INC
CKD-EPI GFR Collaborators 2021, ' A New Panel Estimated GFR, Including β2-Microglobulin and β-Trace Protein and Not Including Race, Developed in a Diverse Population ', American Journal of Kidney Diseases, vol. 77, no. 5, pp. 673-683 . https://doi.org/10.1053/j.ajkd.2020.11.005
ISSN: 1523-6838
0272-6386
DOI: 10.1053/j.ajkd.2020.11.005
Popis: Rationale and Objective: Glomerular filtration rate (GFR) estimation based on creatinine and cystatin C (eGFRcr-cys) is more accurate than estimated GFR (eGFR) based on creatinine or cystatin C alone (eGFRcr or eGFRcys, respectively), but the inclusion of creatinine in eGFRcr-cys requires specification of a person's race. beta 2-Microglobulin (B2M) and beta-trace protein (BTP) are alternative filtration markers that appear to be less influenced by race than creatinine is.Study Design: Study of diagnostic test accuracy.Setting and Participants: Development in a pooled population of 7 studies with 5,017 participants with and without chronic kidney disease. External validation in a pooled population of 7 other studies with 2,245 participants. Tests Compared: Panel eGFR using B2M and BTP in addition to cystatin C (3-marker panel) or creatinine and cystatin C (4-marker panel) with and without age and sex or race. Outcomes: GFRmeasured as the urinary clearance of iothalamate, plasmaclearanceof iohexol, orplasma clearance of [Cr-51]EDTA.Results: Mean measured GFRs were 58.1 and 83.2 mL/min/1.73 m(2), and the proportions of Black participants were 38.6% and 24.0%, in the development and validation populations, respectively. In development, addition of age and sex improved the performance of all equations compared with equations without age and sex, but addition of race did not further improve the performance. In validation, the 4-marker panels were more accurate than the 3-marker panels (P < 0.001). The 3-marker panel without race was more accurate than eGFRcys (percentage of estimates greater than 30% different from measured GFR [1-P30] of 15.6% vs 17.4%; P = 0.01), and the 4-marker panel without race was as accurate as eGFRcr-cys (1-P-30 of 8.6% vs 9.4%; P = 0.2). Results were generally consistent across subgroups.Limitations: No representation of participants with severe comorbid illness and from geographic areas outside of North America and Europe.Conclusions: The 4-marker panel eGFR is as accurate as eGFRcr-cys without requiring specification of race. A more accurate race-free eGFR could be an important advance.
Databáze: OpenAIRE
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