背景：美国国家健康与护理卓越研究所2021年慢性肾脏病（CKD）指南建议使用肾衰竭风险方程（KFRE），其中包括白蛋白尿的测量。计算估计肾小球滤过率（eGFR）的公式也已更新。
目的：研究KFRE和更新的eGFR方程对初级保健中CKD诊断（eGFR<60mL/min/1.73m2）的影响以及可能的肾脏病转诊。
方法：初级保健数据库（安全匿名信息链接数据库[SAIL]）和前瞻性队列研究（UKBiobank），使用2013年至2020年的数据。
方法：使用更新的eGFR方程评估CKD诊断率。在eGFR为30-59mL/min/1.73m2的人群中，确定了以下人群：每年进行白蛋白尿测试的人群和符合肾脏病学转诊标准的人群，原因是：a）eGFR加速下降或明显白蛋白尿；b）eGFR下降<30mL/min/1.73m2；c）仅KFRE>5％。分析在英国生物银行按种族分层。
结果：使用更新的eGFR方程导致SAIL中主要白人人群的新CKD诊断下降了1.2倍，而英国生物银行的黑人参与者的CKD患病率上升了1.9倍。自2015年以来，蛋白尿检测率一直低于30%。在2019年，使用KFRE>5％的患者在eGFR下降之前确定了182/61721（0.3％）的CKD进展高风险患者和361/61721（0.6％）的低危患者不再符合转诊条件。“亚裔”和“其他”种族不成比例地提高了KFRE。
结论：在初级保健中应用KFRE标准将导致更多肾衰竭风险升高的患者（尤其是少数族裔）和更少的低风险患者转诊。需要扩展白蛋白尿测试，以实现更广泛的KFRE实施。
National Institute for Health and Care Excellence 2021
guidelines on chronic kidney disease (CKD) recommend the use of the Kidney Failure Risk Equation (KFRE), which includes measurement of albuminuria. The equation to calculate estimated glomerular filtration rate (eGFR) has also been updated.
To investigate the impact of the use of KFRE and the updated eGFR equation on CKD diagnosis (eGFR <60 mL/min/1.73 m2) in primary care and potential referrals to nephrology.
Primary care database (Secure Anonymised Information Linkage Databank [SAIL]) and prospective cohort study (UK Biobank) using data available between 2013 and 2020.
CKD diagnosis rates were assessed when using the updated eGFR equation. Among people with eGFR 30-59 mL/min/1.73 m2 the following groups were identified: those with annual albuminuria testing and those who met nephrology referral criteria because of: a) accelerated eGFR decline or significant albuminuria; b) eGFR decline <30 mL/ min/1.73 m2 only; and c) KFRE >5% only. Analyses were stratified by ethnicity in UK Biobank.
Using the updated eGFR equation resulted in a 1.2-fold fall in new CKD diagnoses in the predominantly White population in SAIL, whereas CKD prevalence rose by 1.9-fold among Black participants in UK Biobank. Rates of albuminuria testing have been consistently below 30% since 2015. In 2019, using KFRE >5% identified 182/61 721 (0.3%) patients at high risk of CKD progression before their eGFR declined and 361/61 721 (0.6%) low-risk patients who were no longer eligible for referral. Ethnic groups \'Asian\' and \'other\' had disproportionately raised KFREs.
Application of KFRE criteria in primary care will lead to referral of more patients at elevated risk of kidney failure (particularly among minority ethnic groups) and fewer low-risk patients. Albuminuria testing needs to be expanded to enable wider KFRE implementation.
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