New creatinine- and cystatin C-based equations to estimate GFR without race
(2021) In New England Journal of Medicine 385(19). p.1737-1749- Abstract
- Background: Current equations for estimated glomerular filtration rate (eGFR) that use serum creatinine or cystatin C incorporate age, sex, and race to estimate measured GFR. However, race in eGFR equations is a social and not a biologic construct.
Methods: We developed new eGFR equations without race using data from two development data sets: 10 studies (8254 participants, 31.5% Black) for serum creatinine and 13 studies (5352 participants, 39.7% Black) for both serum creatinine and cystatin C. In a validation data set of 12 studies (4050 participants, 14.3% Black), we compared the accuracy of new eGFR equations to measured GFR. We projected the prevalence of chronic kidney disease (CKD) and GFR stages in a sample of U.S. adults,... (More) - Background: Current equations for estimated glomerular filtration rate (eGFR) that use serum creatinine or cystatin C incorporate age, sex, and race to estimate measured GFR. However, race in eGFR equations is a social and not a biologic construct.
Methods: We developed new eGFR equations without race using data from two development data sets: 10 studies (8254 participants, 31.5% Black) for serum creatinine and 13 studies (5352 participants, 39.7% Black) for both serum creatinine and cystatin C. In a validation data set of 12 studies (4050 participants, 14.3% Black), we compared the accuracy of new eGFR equations to measured GFR. We projected the prevalence of chronic kidney disease (CKD) and GFR stages in a sample of U.S. adults, using current and new equations.
Results: In the validation data set, the current creatinine equation that uses age, sex, and race overestimated measured GFR in Blacks (median, 3.7 ml per minute per 1.73 m2 of body-surface area; 95% confidence interval [CI], 1.8 to 5.4) and to a lesser degree in non-Blacks (median, 0.5 ml per minute per 1.73 m2; 95% CI, 0.0 to 0.9). When the adjustment for Black race was omitted from the current eGFR equation, measured GFR in Blacks was underestimated (median, 7.1 ml per minute per 1.73 m2; 95% CI, 5.9 to 8.8). A new equation using age and sex and omitting race underestimated measured GFR in Blacks (median, 3.6 ml per minute per 1.73 m2; 95% CI, 1.8 to 5.5) and overestimated measured GFR in non-Blacks (median, 3.9 ml per minute per 1.73 m2; 95% CI, 3.4 to 4.4). For all equations, 85% or more of the eGFRs for Blacks and non-Blacks were within 30% of measured GFR. New creatinine-cystatin C equations without race were more accurate than new creatinine equations, with smaller differences between race groups. As compared with the current creatinine equation, the new creatinine equations, but not the new creatinine-cystatin C equations, increased population estimates of CKD prevalence among Blacks and yielded similar or lower prevalence among non-Blacks.
Conclusions: New eGFR equations that incorporate creatinine and cystatin C but omit race are more accurate and led to smaller differences between Black participants and non-Black participants than new equations without race with either creatinine or cystatin C alone. (Less)
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- author
- Inker, Lesley A.
; Eneanya, Nwamaka D
; Coresh, Josef
; Tighiouart, Hocine
; Wang, Dan
; Sang, Yingying
; Crews, Deidra C
; Doria, Alessandro
; Estrella, Michelle M
; Froissart, Marc
; Grams, Morgan E
; Greene, Tom
; Grubb, Anders
LU
; Gudnason, Vilmundur
; Gutierrez, Orlando M
; Kalil, Roberto
; Karger, Amy B
; Mauer, Michael
; Navis, Gerjan
; Nelson, Robert G
; Poggio, Emilio D
; Rodby, Roger
; Rossing, Peter
; Rule, Andrew D.
; Selvin, Elizabeth
; Seegmiller, Jesse C
; Shlipak, Michael G.
; Torres, Vicente E
; Yang, Wei
; Ballew, Shoshana H.
; Couture, Sara J
; Powe, Neil R
and Levey, Andrew S.
(Less) - author collaboration
- organization
- publishing date
- 2021-09-23
- type
- Contribution to journal
- publication status
- published
- subject
- in
- New England Journal of Medicine
- volume
- 385
- issue
- 19
- pages
- 1737 - 1749
- publisher
- Massachusetts Medical Society
- external identifiers
-
- scopus:85118607863
- pmid:34554658
- ISSN
- 0028-4793
- DOI
- 10.1056/NEJMoa2102953
- language
- English
- LU publication?
- yes
- id
- c9a7a876-3735-48da-9d59-af5da53ce096
- date added to LUP
- 2021-11-01 13:00:24
- date last changed
- 2023-03-24 23:13:37
@article{c9a7a876-3735-48da-9d59-af5da53ce096,
abstract = {{Background: Current equations for estimated glomerular filtration rate (eGFR) that use serum creatinine or cystatin C incorporate age, sex, and race to estimate measured GFR. However, race in eGFR equations is a social and not a biologic construct.<br/><br/>Methods: We developed new eGFR equations without race using data from two development data sets: 10 studies (8254 participants, 31.5% Black) for serum creatinine and 13 studies (5352 participants, 39.7% Black) for both serum creatinine and cystatin C. In a validation data set of 12 studies (4050 participants, 14.3% Black), we compared the accuracy of new eGFR equations to measured GFR. We projected the prevalence of chronic kidney disease (CKD) and GFR stages in a sample of U.S. adults, using current and new equations.<br/><br/>Results: In the validation data set, the current creatinine equation that uses age, sex, and race overestimated measured GFR in Blacks (median, 3.7 ml per minute per 1.73 m2 of body-surface area; 95% confidence interval [CI], 1.8 to 5.4) and to a lesser degree in non-Blacks (median, 0.5 ml per minute per 1.73 m2; 95% CI, 0.0 to 0.9). When the adjustment for Black race was omitted from the current eGFR equation, measured GFR in Blacks was underestimated (median, 7.1 ml per minute per 1.73 m2; 95% CI, 5.9 to 8.8). A new equation using age and sex and omitting race underestimated measured GFR in Blacks (median, 3.6 ml per minute per 1.73 m2; 95% CI, 1.8 to 5.5) and overestimated measured GFR in non-Blacks (median, 3.9 ml per minute per 1.73 m2; 95% CI, 3.4 to 4.4). For all equations, 85% or more of the eGFRs for Blacks and non-Blacks were within 30% of measured GFR. New creatinine-cystatin C equations without race were more accurate than new creatinine equations, with smaller differences between race groups. As compared with the current creatinine equation, the new creatinine equations, but not the new creatinine-cystatin C equations, increased population estimates of CKD prevalence among Blacks and yielded similar or lower prevalence among non-Blacks.<br/><br/>Conclusions: New eGFR equations that incorporate creatinine and cystatin C but omit race are more accurate and led to smaller differences between Black participants and non-Black participants than new equations without race with either creatinine or cystatin C alone.}},
author = {{Inker, Lesley A. and Eneanya, Nwamaka D and Coresh, Josef and Tighiouart, Hocine and Wang, Dan and Sang, Yingying and Crews, Deidra C and Doria, Alessandro and Estrella, Michelle M and Froissart, Marc and Grams, Morgan E and Greene, Tom and Grubb, Anders and Gudnason, Vilmundur and Gutierrez, Orlando M and Kalil, Roberto and Karger, Amy B and Mauer, Michael and Navis, Gerjan and Nelson, Robert G and Poggio, Emilio D and Rodby, Roger and Rossing, Peter and Rule, Andrew D. and Selvin, Elizabeth and Seegmiller, Jesse C and Shlipak, Michael G. and Torres, Vicente E and Yang, Wei and Ballew, Shoshana H. and Couture, Sara J and Powe, Neil R and Levey, Andrew S.}},
issn = {{0028-4793}},
language = {{eng}},
month = {{09}},
number = {{19}},
pages = {{1737--1749}},
publisher = {{Massachusetts Medical Society}},
series = {{New England Journal of Medicine}},
title = {{New creatinine- and cystatin C-based equations to estimate GFR without race}},
url = {{http://dx.doi.org/10.1056/NEJMoa2102953}},
doi = {{10.1056/NEJMoa2102953}},
volume = {{385}},
year = {{2021}},
}