Race, Genetic Ancestry, and Estimating Kidney Function in CKD
| Autor: | Alan S. Go, Teresa K. Chen, Jianqiao Wang, Jiang He, Chi-yuan Hsu, Katherine T Mills, Sushrut S. Waikar, James P. Lash, Cric Study Investigators, Wei Yang, Afshin Parsa, Harold I. Feldman, Madhumita J Mohanty, Tariq Shafi, Rishi V. Parikh, Milda R Saunders, Anthony N. Muiru, Amanda H. Anderson, Raymond R. Townsend, Debbie L. Cohen, Myles Wolf, Thida C. Tan |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Kidney Disease Genetic genealogy Renal and urogenital MEDLINE Renal function Black People Kidney urologic and male genital diseases Medical and Health Sciences Article Race (biology) Clinical Research General & Internal Medicine Internal medicine Genetics Ethnicity Medicine Humans Renal Insufficiency Chronic Cystatin C Renal Insufficiency Chronic Aged urogenital system business.industry Prevention Racial Groups food and beverages General Medicine Middle Aged female genital diseases and pregnancy complications United States Good Health and Well Being Cross-Sectional Studies Creatinine CRIC Study Investigators Female business Algorithms Glomerular Filtration Rate |
| Zdroj: | The New England journal of medicine, vol 385, iss 19 N Engl J Med |
| ISSN: | 1533-4406 |
| Popis: | BACKGROUND: The inclusion of race in equations to estimate the glomerular filtration rate (GFR) has become controversial. Alternative equations that can be used to achieve similar accuracy without the use of race are needed. METHODS: In a large national study involving adults with chronic kidney disease, we conducted cross-sectional analyses of baseline data from 1248 participants for whom data, including the following, had been collected: race as reported by the participant, genetic ancestry markers, and the serum creatinine, serum cystatin C, and 24-hour urinary creatinine levels. RESULTS: Using current formulations of GFR estimating equations, we found that in participants who identified as Black, a model that omitted race resulted in more underestimation of the GFR (median difference between measured and estimated GFR, 3.99 ml per minute per 1.73 m(2) of body-surface area; 95% confidence interval [CI], 2.17 to 5.62) and lower accuracy (percent of estimated GFR within 10% of measured GFR [P(10)], 31%; 95% CI, 24 to 39) than models that included race (median difference, 1.11 ml per minute per 1.73 m(2); 95% CI, −0.29 to 2.54; P(10), 42%; 95% CI, 34 to 50). The incorporation of genetic ancestry data instead of race resulted in similar estimates of the GFR (median difference, 1.33 ml per minute per 1.73 m(2); 95% CI, −0.12 to 2.33; P(10), 42%; 95% CI, 34 to 50). The inclusion of non-GFR determinants of the serum creatinine level (e.g., body-composition metrics and urinary excretion of creatinine) that differed according to race reported by the participants and genetic ancestry did not eliminate the misclassification introduced by removing race (or ancestry) from serum creatinine–based GFR estimating equations. In contrast, the incorporation of race or ancestry was not necessary to achieve similarly statistically unbiased (median difference, 0.33 ml per minute per 1.73 m(2); 95% CI, −1.43 to 1.92) and accurate (P(10), 41%; 95% CI, 34 to 49) estimates in Black participants when GFR was estimated with the use of cystatin C. CONCLUSIONS: The use of the serum creatinine level to estimate the GFR without race (or genetic ancestry) introduced systematic misclassification that could not be eliminated even when numerous non-GFR determinants of the serum creatinine level were accounted for. The estimation of GFR with the use of cystatin C generated similar results while eliminating the negative consequences of the current race-based approaches. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.) |
| Databáze: | OpenAIRE |
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