New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race

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New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. / Inker, Lesley A.; Eneanya, Nwamaka D.; Coresh, Josef; Tighiouart, Hocine; Wang, Dan; Sang, Yingying; Crews, Deidra C.; Doria, Alessandro; Estrella, Michelle M.; Froissart, Marc; Grams, Morgan E.; Greene, Tom; Grubb, Anders; Gudnason, Vilmundur; Gutierrez, Orlando M.; Kalil, Roberto; Karger, Amy B.; Mauer, Michael; Navis, Gerjan; Nelson, Robert G.; Poggio, Emilio D.; Rodby, Roger; Rossing, Peter; Rule, Andrew D.; Selvin, Elizabeth; Seegmiller, Jesse C.; Shlipak, Michael G.; Torres, Vicente E.; Yang, Wei; Ballew, Shoshana H.; Couture, Sara J.; Powe, Neil R.; Levey, Andrew S.; Chronic Kidney Dis Epidemiology Co.

In: New England Journal of Medicine, Vol. 385, 2021, p. 1737-1749.

Research output: Contribution to journal › Journal article › Research › peer-review

Harvard

Inker, LA, Eneanya, ND, Coresh, J, Tighiouart, H, Wang, D, Sang, Y, Crews, DC, Doria, A, Estrella, MM, Froissart, M, Grams, ME, Greene, T, Grubb, A, Gudnason, V, Gutierrez, OM, Kalil, R, Karger, AB, Mauer, M, Navis, G, Nelson, RG, Poggio, ED, Rodby, R, Rossing, P, Rule, AD, Selvin, E, Seegmiller, JC, Shlipak, MG, Torres, VE, Yang, W, Ballew, SH, Couture, SJ, Powe, NR, Levey, AS & Chronic Kidney Dis Epidemiology Co 2021, 'New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race', New England Journal of Medicine, vol. 385, pp. 1737-1749. https://doi.org/10.1056/NEJMoa2102953

APA

Inker, L. A., Eneanya, N. D., Coresh, J., Tighiouart, H., Wang, D., Sang, Y., Crews, D. C., Doria, A., Estrella, M. M., Froissart, M., Grams, M. E., Greene, T., Grubb, A., Gudnason, V., Gutierrez, O. M., Kalil, R., Karger, A. B., Mauer, M., Navis, G., ... Chronic Kidney Dis Epidemiology Co (2021). New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. New England Journal of Medicine, 385, 1737-1749. https://doi.org/10.1056/NEJMoa2102953

Vancouver

Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y et al. New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. New England Journal of Medicine. 2021;385:1737-1749. https://doi.org/10.1056/NEJMoa2102953

Author

Inker, Lesley A. ; Eneanya, Nwamaka D. ; Coresh, Josef ; Tighiouart, Hocine ; Wang, Dan ; Sang, Yingying ; Crews, Deidra C. ; Doria, Alessandro ; Estrella, Michelle M. ; Froissart, Marc ; Grams, Morgan E. ; Greene, Tom ; Grubb, Anders ; Gudnason, Vilmundur ; Gutierrez, Orlando M. ; Kalil, Roberto ; Karger, Amy B. ; Mauer, Michael ; Navis, Gerjan ; Nelson, Robert G. ; Poggio, Emilio D. ; Rodby, Roger ; Rossing, Peter ; Rule, Andrew D. ; Selvin, Elizabeth ; Seegmiller, Jesse C. ; Shlipak, Michael G. ; Torres, Vicente E. ; Yang, Wei ; Ballew, Shoshana H. ; Couture, Sara J. ; Powe, Neil R. ; Levey, Andrew S. ; Chronic Kidney Dis Epidemiology Co. / New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. In: New England Journal of Medicine. 2021 ; Vol. 385. pp. 1737-1749.

Bibtex

@article{e9e2dddb6ce6469f80eaa0b5868537e9,

title = "New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race",

abstract = "New Equations for Estimating GFR without Race Equations for estimating GFR with serum creatinine overestimate measured GFR in Blacks. The authors report new equations, without race as an inflation factor, using cystatin C and creatinine that reduced errors in estimation between Black participants and non-Black participants.Background Current equations for estimated glomerular filtration rate (eGFR) that use serum creatinine or cystatin C incorporate age, sex, and race to estimate measured GFR. However, race in eGFR equations is a social and not a biologic construct. Methods We developed new eGFR equations without race using data from two development data sets: 10 studies (8254 participants, 31.5% Black) for serum creatinine and 13 studies (5352 participants, 39.7% Black) for both serum creatinine and cystatin C. In a validation data set of 12 studies (4050 participants, 14.3% Black), we compared the accuracy of new eGFR equations to measured GFR. We projected the prevalence of chronic kidney disease (CKD) and GFR stages in a sample of U.S. adults, using current and new equations. Results In the validation data set, the current creatinine equation that uses age, sex, and race overestimated measured GFR in Blacks (median, 3.7 ml per minute per 1.73 m(2) of body-surface area; 95% confidence interval [CI], 1.8 to 5.4) and to a lesser degree in non-Blacks (median, 0.5 ml per minute per 1.73 m(2); 95% CI, 0.0 to 0.9). When the adjustment for Black race was omitted from the current eGFR equation, measured GFR in Blacks was underestimated (median, 7.1 ml per minute per 1.73 m(2); 95% CI, 5.9 to 8.8). A new equation using age and sex and omitting race underestimated measured GFR in Blacks (median, 3.6 ml per minute per 1.73 m(2); 95% CI, 1.8 to 5.5) and overestimated measured GFR in non-Blacks (median, 3.9 ml per minute per 1.73 m(2); 95% CI, 3.4 to 4.4). For all equations, 85% or more of the eGFRs for Blacks and non-Blacks were within 30% of measured GFR. New creatinine-cystatin C equations without race were more accurate than new creatinine equations, with smaller differences between race groups. As compared with the current creatinine equation, the new creatinine equations, but not the new creatinine-cystatin C equations, increased population estimates of CKD prevalence among Blacks and yielded similar or lower prevalence among non-Blacks. Conclusions New eGFR equations that incorporate creatinine and cystatin C but omit race are more accurate and led to smaller differences between Black participants and non-Black participants than new equations without race with either creatinine or cystatin C alone. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.)",

keywords = "GLOMERULAR-FILTRATION-RATE, SERUM CREATININE, NATIONAL-HEALTH, CALIBRATION, PREVALENCE",

author = "Inker, {Lesley A.} and Eneanya, {Nwamaka D.} and Josef Coresh and Hocine Tighiouart and Dan Wang and Yingying Sang and Crews, {Deidra C.} and Alessandro Doria and Estrella, {Michelle M.} and Marc Froissart and Grams, {Morgan E.} and Tom Greene and Anders Grubb and Vilmundur Gudnason and Gutierrez, {Orlando M.} and Roberto Kalil and Karger, {Amy B.} and Michael Mauer and Gerjan Navis and Nelson, {Robert G.} and Poggio, {Emilio D.} and Roger Rodby and Peter Rossing and Rule, {Andrew D.} and Elizabeth Selvin and Seegmiller, {Jesse C.} and Shlipak, {Michael G.} and Torres, {Vicente E.} and Wei Yang and Ballew, {Shoshana H.} and Couture, {Sara J.} and Powe, {Neil R.} and Levey, {Andrew S.} and {Chronic Kidney Dis Epidemiology Co}",

year = "2021",

doi = "10.1056/NEJMoa2102953",

language = "English",

volume = "385",

pages = "1737--1749",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachusetts Medical Society",

}

RIS

TY - JOUR

T1 - New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race

AU - Inker, Lesley A.

AU - Eneanya, Nwamaka D.

AU - Coresh, Josef

AU - Tighiouart, Hocine

AU - Wang, Dan

AU - Sang, Yingying

AU - Crews, Deidra C.

AU - Doria, Alessandro

AU - Estrella, Michelle M.

AU - Froissart, Marc

AU - Grams, Morgan E.

AU - Greene, Tom

AU - Grubb, Anders

AU - Gudnason, Vilmundur

AU - Gutierrez, Orlando M.

AU - Kalil, Roberto

AU - Karger, Amy B.

AU - Mauer, Michael

AU - Navis, Gerjan

AU - Nelson, Robert G.

AU - Poggio, Emilio D.

AU - Rodby, Roger

AU - Rossing, Peter

AU - Rule, Andrew D.

AU - Selvin, Elizabeth

AU - Seegmiller, Jesse C.

AU - Shlipak, Michael G.

AU - Torres, Vicente E.

AU - Yang, Wei

AU - Ballew, Shoshana H.

AU - Couture, Sara J.

AU - Powe, Neil R.

AU - Levey, Andrew S.

AU - Chronic Kidney Dis Epidemiology Co

PY - 2021

Y1 - 2021

N2 - New Equations for Estimating GFR without Race Equations for estimating GFR with serum creatinine overestimate measured GFR in Blacks. The authors report new equations, without race as an inflation factor, using cystatin C and creatinine that reduced errors in estimation between Black participants and non-Black participants.Background Current equations for estimated glomerular filtration rate (eGFR) that use serum creatinine or cystatin C incorporate age, sex, and race to estimate measured GFR. However, race in eGFR equations is a social and not a biologic construct. Methods We developed new eGFR equations without race using data from two development data sets: 10 studies (8254 participants, 31.5% Black) for serum creatinine and 13 studies (5352 participants, 39.7% Black) for both serum creatinine and cystatin C. In a validation data set of 12 studies (4050 participants, 14.3% Black), we compared the accuracy of new eGFR equations to measured GFR. We projected the prevalence of chronic kidney disease (CKD) and GFR stages in a sample of U.S. adults, using current and new equations. Results In the validation data set, the current creatinine equation that uses age, sex, and race overestimated measured GFR in Blacks (median, 3.7 ml per minute per 1.73 m(2) of body-surface area; 95% confidence interval [CI], 1.8 to 5.4) and to a lesser degree in non-Blacks (median, 0.5 ml per minute per 1.73 m(2); 95% CI, 0.0 to 0.9). When the adjustment for Black race was omitted from the current eGFR equation, measured GFR in Blacks was underestimated (median, 7.1 ml per minute per 1.73 m(2); 95% CI, 5.9 to 8.8). A new equation using age and sex and omitting race underestimated measured GFR in Blacks (median, 3.6 ml per minute per 1.73 m(2); 95% CI, 1.8 to 5.5) and overestimated measured GFR in non-Blacks (median, 3.9 ml per minute per 1.73 m(2); 95% CI, 3.4 to 4.4). For all equations, 85% or more of the eGFRs for Blacks and non-Blacks were within 30% of measured GFR. New creatinine-cystatin C equations without race were more accurate than new creatinine equations, with smaller differences between race groups. As compared with the current creatinine equation, the new creatinine equations, but not the new creatinine-cystatin C equations, increased population estimates of CKD prevalence among Blacks and yielded similar or lower prevalence among non-Blacks. Conclusions New eGFR equations that incorporate creatinine and cystatin C but omit race are more accurate and led to smaller differences between Black participants and non-Black participants than new equations without race with either creatinine or cystatin C alone. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.)

AB - New Equations for Estimating GFR without Race Equations for estimating GFR with serum creatinine overestimate measured GFR in Blacks. The authors report new equations, without race as an inflation factor, using cystatin C and creatinine that reduced errors in estimation between Black participants and non-Black participants.Background Current equations for estimated glomerular filtration rate (eGFR) that use serum creatinine or cystatin C incorporate age, sex, and race to estimate measured GFR. However, race in eGFR equations is a social and not a biologic construct. Methods We developed new eGFR equations without race using data from two development data sets: 10 studies (8254 participants, 31.5% Black) for serum creatinine and 13 studies (5352 participants, 39.7% Black) for both serum creatinine and cystatin C. In a validation data set of 12 studies (4050 participants, 14.3% Black), we compared the accuracy of new eGFR equations to measured GFR. We projected the prevalence of chronic kidney disease (CKD) and GFR stages in a sample of U.S. adults, using current and new equations. Results In the validation data set, the current creatinine equation that uses age, sex, and race overestimated measured GFR in Blacks (median, 3.7 ml per minute per 1.73 m(2) of body-surface area; 95% confidence interval [CI], 1.8 to 5.4) and to a lesser degree in non-Blacks (median, 0.5 ml per minute per 1.73 m(2); 95% CI, 0.0 to 0.9). When the adjustment for Black race was omitted from the current eGFR equation, measured GFR in Blacks was underestimated (median, 7.1 ml per minute per 1.73 m(2); 95% CI, 5.9 to 8.8). A new equation using age and sex and omitting race underestimated measured GFR in Blacks (median, 3.6 ml per minute per 1.73 m(2); 95% CI, 1.8 to 5.5) and overestimated measured GFR in non-Blacks (median, 3.9 ml per minute per 1.73 m(2); 95% CI, 3.4 to 4.4). For all equations, 85% or more of the eGFRs for Blacks and non-Blacks were within 30% of measured GFR. New creatinine-cystatin C equations without race were more accurate than new creatinine equations, with smaller differences between race groups. As compared with the current creatinine equation, the new creatinine equations, but not the new creatinine-cystatin C equations, increased population estimates of CKD prevalence among Blacks and yielded similar or lower prevalence among non-Blacks. Conclusions New eGFR equations that incorporate creatinine and cystatin C but omit race are more accurate and led to smaller differences between Black participants and non-Black participants than new equations without race with either creatinine or cystatin C alone. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.)

KW - GLOMERULAR-FILTRATION-RATE

KW - SERUM CREATININE

KW - NATIONAL-HEALTH

KW - CALIBRATION

KW - PREVALENCE

U2 - 10.1056/NEJMoa2102953

DO - 10.1056/NEJMoa2102953

M3 - Journal article

C2 - 34554658

VL - 385

SP - 1737

EP - 1749

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

ER -

ID: 281651803