Estimated GFR in the Korean and US Asian Populations Using the 2021 Creatinine-Based GFR Estimating Equation Without Race

IF 3.2 Q1 UROLOGY & NEPHROLOGY Kidney Medicine Pub Date : 2024-08-14 DOI:10.1016/j.xkme.2024.100890
Jimin Hwang , Kwanghyun Kim , Josef Coresh , Lesley A. Inker , Morgan E. Grams , Jung-Im Shin
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Abstract

Rationale & Objective

In 2021, the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) updated the creatinine-based estimated glomerular filtration rate (eGFR) equation and removed the coefficient for race. The development and validation of this equation involved binarizing race into African American and non-African American, involving few Asian participants. This study aimed to examine the difference between the 2021 equation and the previous 2009 equation on CKD prevalence estimates in 2 Asian populations.

Study Design

Observational study using 2 national surveys.

Setting & Participants

Participants from the 2019 Korea National Health and Nutrition Survey and participants self-reported as Asian from the 2011-2020 US National Health and Nutrition Survey.

Exposure

eGFR using 2009 and 2021 CKD-EPI creatinine equation.

Outcomes

Prevalence of CKD (eGFR <60 mL/min/1.73 m2 or urine albumin-creatinine ratio ≥30 mg/g).

Analytical Approach

Sampling-weighted prevalence estimated using the 2009 and 2021 equations as well as the percentage of individuals with CKD G3+ using the 2009 equation being reclassified as not having CKD G3+ using the 2021 equation.

Results

The prevalence of CKD estimated using the 2021 equation was 9.75% (95% confidence intervals [CI], 8.80-10.80%) in Koreans and 11.60% (95% CI, 10.23-13.13%) in US Asians. The prevalence of CKD estimated using the 2021 equation was slightly lower than that using the 2009 equation in both Korean and US Asian populations by 0.63% (95% CI, 0.44-0.90%) and 0.84% (95% CI, 0.52-1.34%), respectively. Furthermore, 32.8% and 30.2% of Koreans and US Asians with CKD G3-5, respectively, estimated using the 2009 equation were reclassified as not having CKD G3-5 when the eGFR was calculated using the 2021 equation.

Limitations

Measured GFR was not available.

Conclusions

Use of the 2021 CKD-EPI creatinine equation leads to a small decrease in CKD prevalence in both Korean and US Asian populations, and of similar magnitude, resulting in significant reclassification among those originally classified as having CKD G3+.

Plain-Language Summary

The 2009 serum creatinine-based kidney function estimating equation used demographic information including race. Because race is a social construct, race was eliminated in the new equation developed in 2021. As race was categorized into African American and non-African American during its development, this study examined the impact of the 2021 equation in 2 distinct Asian populations (Koreans and US Asians) using 2 national datasets. We found that the prevalence of chronic kidney disease (CKD) estimated using the 2021 equation was slightly lower that estimated using the 2009 equation in both Koreans and US Asians. Approximately one-third of people with CKD estimated using the 2009 equation were reclassified as not having CKD estimated using the 2021 equation.

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使用基于肌酸酐的 2021 年无种族 GFR 估算公式估算韩国和美国亚裔人口的 GFR
理由与amp; 目标2021年,新的慢性肾脏病流行病学合作组织(CKD-EPI)更新了基于肌酐的估计肾小球滤过率(eGFR)方程,并取消了种族系数。该方程的开发和验证涉及将种族分为非洲裔美国人和非非洲裔美国人,很少有亚裔参与者参与。本研究旨在检验 2021 年方程与之前的 2009 年方程在 2 个亚洲人群中的 CKD 患病率估计值之间的差异。研究设计使用 2 项全国性调查进行观察性研究。结果CKD患病率(eGFR <60毫升/分钟/1.73平方米或尿白蛋白-肌酐比值≥30毫克/克).分析方法使用2009年和2021年方程估算的抽样加权患病率,以及使用2009年方程估算的CKD G3+患者中使用2021年方程重新分类为非CKD G3+患者的百分比。结果使用 2021 年方程估计的韩国人 CKD 患病率为 9.75%(95% 置信区间 [CI],8.80-10.80%),美国亚裔为 11.60%(95% 置信区间 [CI],10.23-13.13%)。在韩国和美国的亚裔人群中,使用 2021 年方程估计的 CKD 患病率比使用 2009 年方程估计的患病率略低,分别为 0.63% (95% CI, 0.44-0.90%) 和 0.84% (95% CI, 0.52-1.34%)。此外,在使用 2009 年方程估计的 CKD G3-5 韩国人和美国亚洲人中,分别有 32.8% 和 30.2% 的人在使用 2021 年方程计算 eGFR 时被重新归类为未患 CKD G3-5。结论使用 2021 年 CKD-EPI 肌酐方程会导致韩国和美国亚裔人群的 CKD 患病率略有下降,且下降幅度相似,从而导致原本被归类为 CKD G3+ 的人群被重新显著分类。由于种族是一种社会建构,因此在 2021 年开发的新方程中取消了种族。由于在开发过程中将种族分为非洲裔美国人和非非洲裔美国人,本研究利用两个国家的数据集研究了 2021 年方程对两个不同亚洲人群(韩国人和美国亚洲人)的影响。我们发现,在韩国人和美国亚洲人中,使用 2021 年方程估算的慢性肾病 (CKD) 患病率略低于使用 2009 年方程估算的患病率。在使用 2009 年方程估计的慢性肾脏病患者中,约有三分之一的人被重新归类为使用 2021 年方程估计的非慢性肾脏病患者。
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来源期刊
Kidney Medicine
Kidney Medicine Medicine-Internal Medicine
CiteScore
4.80
自引率
5.10%
发文量
176
审稿时长
12 weeks
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