{"id":21992,"date":"2022-07-31T05:08:32","date_gmt":"2022-07-30T21:08:32","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=21992"},"modified":"2022-07-31T09:01:34","modified_gmt":"2022-07-31T01:01:34","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%87%87%e7%94%a8%e4%b8%8e%e7%a7%8d%e6%97%8f%e6%97%a0%e5%85%b3%e7%9a%84%e5%85%ac%e5%bc%8f%e8%ae%a1%e7%ae%97egfr%e4%b8%8e%e9%bb%91%e4%ba%ba%e5%92%8c","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=21992","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u91c7\u7528\u4e0e\u79cd\u65cf\u65e0\u5173\u7684\u516c\u5f0f\u8ba1\u7b97eGFR\u4e0e\u9ed1\u4eba\u548c\u975e\u9ed1\u4eba\u80be\u529f\u80fd\u8870\u7aed\u53ca\u75c5\u6b7b\u7387\u7684\u76f8\u5173\u6027"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

June 6, 2022<\/p>\n\n\n\n

Association of Estimated GFR Calculated Using Race-Free Equations With Kidney Failure and Mortality by Black vs Non-Black Race<\/h1>\n\n\n\n

Orlando M.\u00a0Guti\u00e9rrez,\u00a0Yingying\u00a0Sang,\u00a0Morgan E.\u00a0Grams,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online June 6, 2022. doi:10.1001\/jama.2022.8801<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Compared with estimated glomerular filtration rate (eGFR) equations that include Black vs non-Black race or cystatin C, do eGFR equations without race or cystatin C alter estimates of racial differences in risk of kidney failure requiring replacement therapy and mortality?<\/p>\n\n\n\n

Findings<\/strong>  In this retrospective individual-level data analysis of 62\u202f011 participants, decreased eGFR was related to higher risk for all equations and within both racial groups. Compared with alternative equations, the creatinine-based eGFR equation without race attenuated racial differences in the risk of kidney failure requiring replacement therapy and mortality at normal eGFR and showed no significant racial differences in the risk at reduced eGFR.<\/p>\n\n\n\n

Meaning<\/strong>  Among eGFR equations without race, the equation including both creatinine and cystatin C, but not the equation including creatinine without cystatin C, demonstrated racial differences in the risk of kidney failure requiring replacement therapy and mortality.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  At a given estimated glomerular filtration rate (eGFR), individuals who are Black have higher rates of mortality and kidney failure with replacement therapy (KFRT) compared with those who are non-Black. Whether the recently adopted eGFR equations without race preserve racial differences in risk of mortality and KFRT at a given eGFR is unknown.<\/p>\n\n\n\n

Objective<\/strong>  To assess whether eGFR equations with and without race and cystatin C document racial differences in risk of KFRT and mortality in populations including Black and non-Black participants.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Retrospective individual-level data analysis of 62\u202f011 participants from 5 general population and 3 chronic kidney disease (CKD) US-based cohorts with serum creatinine, cystatin C, and follow-up for KFRT and mortality from 1988 to 2018.<\/p>\n\n\n\n

Exposures<\/strong>  Chronic Kidney Disease Epidemiology Collaboration equation with serum creatinine (eGFRcr with and without race), cystatin C (eGFRcys without race), or both markers (eGFRcr-cys without race).<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The prevalence of decreased eGFR at baseline and hazard ratios of KFRT and mortality in Black vs non-Black participants were calculated, adjusted for age and sex. Analyses were performed within each cohort and with random-effect meta-analyses of the models.<\/p>\n\n\n\n

Results<\/strong>  Among 62\u202f011 participants (20\u202f773 Black and 41\u202f238 non-Black; mean age, 63 years; 53% women), the prevalence ratio (95% CI; percent prevalences) of eGFR less than 60 mL\/min\/1.73 m2<\/sup> comparing Black with non-Black participants was 0.98 (95% CI, 0.93-1.03; 11% vs 12%) for eGFRcr with race, 0.95 (95% CI, 0.91-0.98; 17% vs 18%) for eGFRcys, and 1.2 (95% CI, 1.2-1.3; 13% vs 11%) for eGFRcr-cys but was 1.8 (95% CI, 1.7-1.8; 15% vs 9%) for eGFRcr without race. During a mean follow-up of 13 years, 8% and 4% of Black and non-Black participants experienced KFRT and 34% and 39% died, respectively. Decreased eGFR was associated with significantly greater risk of both outcomes for all equations. At an eGFR of 60 mL\/min\/1.73 m2<\/sup>, the hazard ratios for KFRT comparing Black with non-Black participants were 2.8 (95% CI, 1.6-4.9) for eGFRcr with race, 3.0 (95% CI, 1.5-5.8) for eGFRcys, and 2.8 (95% CI, 1.4-5.4) for eGFRcr-cys vs 1.3 (95% CI, 0.8-2.1) for eGFRcr without race. The 5-year absolute risk differences for KFRT comparing Black with non-Black participants were 1.4% (95% CI, 0.2%-2.6%) for eGFRcr with race, 1.1% (95% CI, 0.2%-1.9%) for eGFRcys, and 1.3% (95% CI, 0%-2.6%) for eGFRcr-cys vs 0.37% (95% CI, \u22120.32% to 1.05%) for eGFRcr without race. Similar patterns were observed for mortality.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this retrospective analysis of 8 US cohorts including Black and non-Black individuals, the eGFR equation without race that included creatinine and cystatin C, but not the eGFR equation without race that included creatinine without cystatin C, demonstrated racial differences in the risk of KFRT and mortality throughout the range of eGFR. The eGFRcr-cys equation may be preferable to the eGFRcr equation without race for assessing racial differences in the risk of KFRT and mortality associated with low eGFR.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  June 6, 2022 Ass […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21992"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=21992"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21992\/revisions"}],"predecessor-version":[{"id":22344,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21992\/revisions\/22344"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=21992"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=21992"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=21992"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}