AI 中文总结
研究针对多民族大群体，比较估算肾功能及肾衰竭风险的方程。通过回顾性多中心队列研究，发现新老方程在GFR估计及对肾衰竭判别能力上有差异，且CKD患病率因方程选择和地区而异，揭示新方程的不同有广泛意义。
AI 中文摘要
背景：慢性肾病（CKD）患者肾功能恶化及后续发展为肾衰竭的速率各异。为优化临床决策，需准确评估患者当前及未来肾功能。方法：开展一项回顾性多中心队列研究，涉及初级保健、急性护理和医院环境，纳入1909042名在2012 - 2014年至少有一次血清肌酐测量记录且随访至2025年1月的成年人。主要结局是不同种族地区的受试者工作特征曲线下面积及各阶段CKD患病率。结果：两个种族分层方程（2006 MDRD和2009 CKD - EPI）的GFR估计校准相似。两个种族中性方程的GFR估计有差异，2021 EKFC产生较低GFR估计，2021 CKD - EPI产生较高GFR估计。2006 MDRD在5年内对肾衰竭的判别能力最强，2021 EKFC最弱，其AUROCs分别为0.862（95% CI，0.855 - 0.869）和0.846（95% CI，0.838 - 0.853）。CKD的年龄调整患病率因eGFR方程选择及出生地区而异。结论：通过对近200万人10年随访，研究表明新开发的美国和欧洲方程与先前推荐方程不同，具有广泛临床和流行病学意义。
英文摘要
Background: Patients with chronic kidney disease (CKD) experience worsening kidney function and develop subsequent kidney failure at different rates. Accurate estimates of a patient's current and future kidney function are needed for optimal clinical decision-making. Methods: To compare current and previously recommended equations for estimating kidney function and risk of kidney failure across a large multiethnic population, we conducted a retrospective multicenter cohort study of primary care, acute care, and hospital settings. Our study population comprised 1,909,042 adults with at least one recorded serum creatinine measurement during 2012-2014, with follow-up until January 2025. Our primary outcomes were the area under the receiver operating characteristic curve and prevalence of CKD by stage across regions of origin. Findings: GFR estimates from the two race-stratified equations (2006 MDRD and 2009 CKD-EPI) were similarly calibrated. GFR estimates from the two race-neutral equations diverged, with 2021 EKFC producing lower GFR estimates and 2021 CKD-EPI producing higher GFR estimates compared to prior equations. The oldest equation, 2006 MDRD, was the most discriminative of kidney failure within 5 years while the newer European equation, 2021 EKFC, was the least discriminative, with AUROCs of 0.862 (95% CI, 0.855-0.869) and 0.846 (95% CI, 0.838-0.853), respectively. The age-adjusted prevalence of CKD varied by the choice of eGFR equation (ranging from 8.5% for 2021 CKD-EPI to 10.8% for EKFC) and across regions of birth (ranging from 8.9% for East Sub-Saharan Africa to 15.3% for South Asia). Interpretation: Using 10 years of follow-up for nearly 2 million individuals, our study demonstrates how newly developed US and European equations diverge from previously recommended equations with broad clinical and epidemiological implications.
