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【热门文献】eGFR和种族能否影响肾衰竭死亡率

文献解读

2022-06-17      

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Gutiérrez OM et al.JAMA. 2022 Jun 6.


在给定的肾小球滤过率(eGFR)下,与非黑人相比,黑人患者在接受替代治疗(KFRT)后的死亡率和肾衰竭发生率更高。特定eGFR下死亡风险和KFRT的种族差异尚不清楚。研究将慢性肾脏疾病流行病学与血清肌酐(有种族和没有种族的eGFRcr),胱抑制素C(无种族的eGFRcys),或两者标记(无种族的eGFRcr-cys)


研究纳入62 011例患者(20773例黑人和41238例非黑人),在平均13年的随访中,8%和4%的黑人和非黑人参与者经历了KFRT, 34%和39%的人死亡。eGFR降低与两种结果的风险显著增加相关。黑人与非黑人参与者之间KFRT的5年绝对风险差异为:有种族的eGFRcr为1.4% (95% CI, 0.2%-2.6%), eGFRcys为1.1% (95% CI, 0.2%-1.9%), eGFRcr-cys为1.3% (95% CI, 0%-2.6%),无种族的eGFRcr为0.37% (95% CI, -0.32% - 1.05%)


在这项回顾性分析中,不含种族的eGFR方程(包括肌酐和胱抑素C),而包含种族的eGFR方程(包括肌酐和胱抑素C),结果表明在整个eGFR范围内KFRT的风险和死亡率存在种族差异。在评估与低eGFR相关的KFRT风险和死亡率的种族差异方面,eGFRcr-cys方程可能比无种族的eGFRcr方程更可取


Importance: 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.

Objective: 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.

Design, setting, and participants: Retrospective individual-level data analysis of 62 011 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.

Exposures: 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).

Main outcomes and measures: 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.

Results: Among 62 011 participants (20 773 Black and 41 238 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 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, 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, -0.32% to 1.05%) for eGFRcr without race. Similar patterns were observed for mortality.

Conclusions and relevance: 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.



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