TY - JOUR
T1 - A New Panel-Estimated GFR, Including β2-Microglobulin and β-Trace Protein and Not Including Race, Developed in a Diverse Population
AU - CKD-EPI GFR Collaborators
AU - Inker, Lesley A.
AU - Couture, Sara J.
AU - Tighiouart, Hocine
AU - Abraham, Alison G.
AU - Beck, Gerald J.
AU - Feldman, Harold I.
AU - Greene, Tom
AU - Gudnason, Vilmundur
AU - Karger, Amy B.
AU - Eckfeldt, John H.
AU - Kasiske, Bertram L.
AU - Mauer, Michael
AU - Navis, Gerjan
AU - Poggio, Emilio D.
AU - Rossing, Peter
AU - Shlipak, Michael G.
AU - Levey, Andrew S.
AU - Andresdottir, Margret B.
AU - Gudmundsdottir, Hrefna
AU - Indridason, Olafur S.
AU - Palsson, Runolfur
AU - Kimmel, Paul
AU - Weir, Matt
AU - Kalil, Roberto
AU - Pesavento, Todd
AU - Porter, Anna
AU - Taliercio, Jonathan
AU - Hsu, Chi yuan
AU - Chen, Jing
AU - Sinkeler, Steef
AU - Wyatt, Christina
AU - Krishnasami, Zipporah
AU - Hellinger, James
AU - Margolick, Joseph
AU - Kingsley, Lawrence
AU - Witt, Mallory
AU - Wolinsky, Steven
AU - Shafi, Tariq
AU - Post, Wendy
AU - Doria, Alessandro
AU - Parving, Hans Henrik
N1 - Publisher Copyright:
© 2020 National Kidney Foundation, Inc.
PY - 2021/5
Y1 - 2021/5
N2 - 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. β2-Microglobulin (B2M) and β-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: GFR measured as the urinary clearance of iothalamate, plasma clearance of iohexol, or plasma clearance of [51Cr]EDTA. Results: Mean measured GFRs were 58.1 and 83.2 mL/min/1.73 m2, 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 − P30 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.
AB - 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. β2-Microglobulin (B2M) and β-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: GFR measured as the urinary clearance of iothalamate, plasma clearance of iohexol, or plasma clearance of [51Cr]EDTA. Results: Mean measured GFRs were 58.1 and 83.2 mL/min/1.73 m2, 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 − P30 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.
KW - African American
KW - Black race
KW - GFR estimation
KW - Glomerular filtration rate (GFR)
KW - bias
KW - creatinine
KW - cystatin C
KW - estimating equations
KW - filtration marker
KW - kidney disease diagnosis
KW - laboratory testing
KW - race
KW - race-based medicine
KW - renal function
KW - β-microglobulin (B2M)
KW - β-trace protein (BTP)
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U2 - 10.1053/j.ajkd.2020.11.005
DO - 10.1053/j.ajkd.2020.11.005
M3 - Article
C2 - 33301877
AN - SCOPUS:85103945058
SN - 0272-6386
VL - 77
SP - 673-683.e1
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -