■2021年CKD-EPI将Black种族作为计算估计的肾小球滤过率(eGFR)的一个因素。我们评估了其对人口统计学上不同的美国军事卫生系统中CKD患病率的影响。
■使用2009年和2021年CKD-EPI方程对2016-2019年期间测量的血清肌酐进行eGFR的回顾性计算。
■多中心医疗保健网络,完整病例分析中的数据来自1,502,607名成年人,估算种族分析中的数据来自1,970,433名成年人。
■血清肌酐,年龄,性别,和种族。
■CKD3-5期,定义为最后一个eGFR持续<60mL/min/1.73m2≥90天。
■连续变量采用t检验和Kruskal-Wallis检验,分类数据采用X2检验。
■在完整病例分析中,人口的中位年龄为40岁,黑人占18.8%,女性占35.4%。根据2021年的方程,患有CKD3-5期的黑人成年人的数量从4,147增加到6,556,增加了58.1%,粗患病率从1.47%变化到2.32%。患有CKD3-5期的非黑人成年人的数量从27,596下降到19,213,下降了30.4%,患病率从2.26%下降到1.58%。种族归因也看到了类似的结果。累计,在CKD3-5期的成年人中,至少有一个方程,45.8%的黑人成年人被重新分类到CKD的更晚期阶段,44.0%的非黑人成年人被重新分类到eGFR阈值中不那么严重的阶段,这可能会改变临床管理。
■在仅进行1次测量的个体中,CKD的潜在低估。
■在军事卫生系统中采用2021年CKD-EPI方程,将许多黑人成年人重新分类为新的CKD3-5阶段或更高级的CKD阶段,对非黑人成年人产生相反的影响。这可能以未知的方式对CKD治疗和结果产生影响。
直到最近,如果个体是黑人种族,则根据调整结果的方程式计算肾功能水平。因为这可能会导致肾脏疾病护理方面的种族差异,2021年建立了一个新的等式,将种族作为一个因素排除在外。我们使用2016年至2019年美国军事卫生系统成年人的数据评估了该方程的可能影响。有了新的等式,被分类为肾脏疾病的黑人成年人的数量增加,而非黑人成年人的数量减少。在更严重的肾脏疾病中也有类似的趋势,这可能会影响临床护理的决策。这些结果强调了用新方程监测的潜在积极和消极结果。
UNASSIGNED: The 2021 CKD-EPI removes Black race as a factor in calculating the estimated glomerular filtration rate (eGFR). We assessed its effect on CKD prevalence in the demographically-diverse US Military Health System.
UNASSIGNED: A retrospective calculation of the eGFR from serum creatinine measured over 2016-2019 using both the 2009 and 2021 CKD-EPI equations.
UNASSIGNED: Multicenter health care network with data from 1,502,607 adults in the complete case analysis and from 1,970,433 adults in an imputed race analysis.
UNASSIGNED: Serum creatinine, age, sex, and race.
UNASSIGNED: CKD stages 3-5, defined as the last eGFR persistently < 60 mL/min/1.73m2 for ≥90 days.
UNASSIGNED: The t test and Kruskal-Wallis test were used for continuous variables and Χ2 for categorical data.
UNASSIGNED: The population in the complete case analysis had a median age of 40 years and was 18.8% Black race and 35.4% female. With the 2021 equation, the number of Black adults with CKD stages 3-5 increased by 58.1% from 4,147 to 6,556, a change in the crude prevalence from 1.47% to 2.32%. The number of non-Black adults with CKD stages 3-5 decreased by 30.4% from 27,596 to 19,213, a crude prevalence change from 2.26% to 1.58%. Similar results were seen with race imputation. Cumulatively, among adults with CKD stages 3-5 by at least one equation, 45.8% of Black adults were reclassified to more advanced stages of CKD and 44.0% of non-Black adults were reclassified to less severe stages across eGFR thresholds that could change clinical management.
UNASSIGNED: Potential underestimation of CKD in individuals with only 1 measurement.
UNASSIGNED: Adoption of the 2021 CKD-EPI equation in the Military Health System reclassifies many Black adults into new CKD stages 3-5 or into more advanced CKD stages, with the opposite effect on non-Black adults. This may have an effect on CKD treatment and outcomes in ways that are yet unknown.
Until recently, kidney function level was calculated from equations that adjusted the result if the individual was of Black race. Because this may contribute to racial disparities in kidney disease care, a new equation was developed in 2021 that excludes race as a factor. We assessed the possible effects of this equation using data from adults in the US Military Health System from 2016 to 2019. With the new equation, the number of Black adults classified with kidney disease increased while that of non-Black adults decreased. There were similar trends seen in the more severe levels of kidney disease, which could affect decisions in clinical care. These results emphasize the potential positive and negative outcomes to be monitored with the new equation.