[en] ABSTRACT
Background
The 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is the most used equation to estimate glomerular filtration rate (GFR), with race being a factor thereof, increasing GFR by 16% in self-identified Black persons compared with non-Black persons. However, recent publications indicate that it might overestimate GFR for Black adults outside the USA. In this meta-analysis, we assessed the accuracy, evaluated by the percentage of estimated GFR within 30% of measured GFR (P30), of the 2009 CKD-EPI equation in estimating GFR with and without the race coefficient in Black individuals outside the United States of America (USA).
Methods
We searched MEDLINE and Embase from inception to 9 July 2022, with no language restriction, supplemented by manual reference searches. Studies that assessed the CKD-EPI P30 accuracy with or without the race coefficient in Black adults outside the USA with an adequate method of GFR measurement were included. Data were extracted by independent pairs of reviewers and were pooled using a random-effects model.
Results
We included 11 studies, with a total of 1834 Black adults from South America, Africa and Europe. The race coefficient in the 2009 CKD-EPI equation significantly decreased P30 accuracy {61.9% [95% confidence interval (CI) 53–70%] versus 72.9% [95% CI 66.7–78.3%]; P = .03}.
Conclusions
Outside the USA, the 2009 CKD-EPI equation should not be used with the race coefficient, even though the 2009 CKD-EPI equation is not sufficiently accurate either way (<75%). Thus we endorse the Kidney Disease: Improving Global Outcomes guidelines to use exogenous filtration markers when this may impact clinical conduct.
Disciplines :
Urology & nephrology
Author, co-author :
Zingano, Carolina Pires ; Graduate Program in Medical Sciences: Endocrinology, Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre , Brazil ; Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre , Porto , Alegre
Escott, Gustavo Monteiro; Graduate Program in Medical Sciences: Endocrinology, Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre , Brazil ; Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre , Porto , Alegre
Rocha, Bruna Martins; Graduate Program in Medical Sciences: Endocrinology, Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre , Brazil ; Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre , Porto , Alegre
Porgere, Indianara Franciele; Graduate Program in Medical Sciences: Endocrinology, Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre , Brazil ; Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre , Porto , Alegre
Moro, Candice Cristine; Graduate Program in Medical Sciences: Endocrinology, Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre , Brazil ; Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre , Porto , Alegre
Delanaye, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie ; Department of Nephrology-Dialysis-Apheresis , Hôpital Universitaire Carémeau, Nîmes , France
Silveiro, Sandra Pinho; Graduate Program in Medical Sciences: Endocrinology, Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre , Brazil ; Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre , Porto , Alegre ; Division of Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
Language :
English
Title :
2009 CKD-EPI glomerular filtration rate estimation in Black individuals outside the United States: a systematic review and meta-analysis
HCPA - Hospital de Clínicas de Porto Alegre [BR] UFRGS - Universidade Federal do Rio Grande do Su [BR] FAPERGS - Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul [BR] CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico [BR] CAPES - Coordenação de Aperfeicoamento de Pessoal de Nível Superior [BR]
Funding text :
Funding was received from the Hospital de Clínicas de Porto
Alegre Research Fund (FIPE-HCPA), the Division of Research of
Universidade Federal do Rio Grande do Sul (PROPESQ-UFRGS),
Fundação de Amparo à Pesquisa do Estado do Rio Grande do
Sul (FAPERGS; process number 16/2551-00a00-476-5), Conselho
Nacional de Desenvolvimento Científico e Tecnológico (CNPq),
Hospital de Clínicas de Porto Alegre (HCPA) and Coordenação
de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). This
study was financed in part by the Coordenação de Aperfeiçoamento
de Pessoal de Nível Superior–Brasil (CAPES; finance code
001).