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采用CKD-EPI (2021) 来估计膜过率:对英国实践的影响
Reuben Roy1,2, Maharajan Raman2, Paul M Dark1,2
1Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.
Nephron
|September 29, 2024
概括
估计膜过率 (GFR) 的新无种族方程可以重新分类英国超过73万慢性病 (CKD) 患者,影响医疗保健服务,并可能解决健康不平等问题.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 公共卫生 公共卫生
- 医学统计 医学统计
背景情况:
- 估计膜过率 (GFR) 的方程对于诊断和分期慢性病 (CKD) 至关重要.
- 目前的GFR估计方程,包括2009年病饮食修改 (MDRD) 和CKD-流行病学协作 (CKD-EPI),因纳入种族而受到批评,可能导致偏见.
- 最近的建议主张不涉及种族的GFR估计方程,促使评估它们对患者群体的影响.
研究的目的:
- 评估采用无种族GFR估计方程对英国一家大型教学医院中慢性病患者群体的影响.
- 为了比较四个GFR估计方程的性能:MDRD,CKD-EPI (2009),CKD-EPI (2021),以及欧洲功能联盟 (EKFC).
- 分析不同的人口分组的偏见和精度,包括年龄,族群,CKD阶段和性别.
主要方法:
- 使用布兰德-阿尔特曼方法来比较四个GFR估计方程:MDRD,CKD-EPI (2009),CKD-EPI (2021) 和EKFC.
- 对于整个CKD队列和特定子组的绝对和百分比计算偏差和精度.
- 评估CKD分期使用每个患者所有四个方程.
主要成果:
- 与CKD-EPI (2021) 相比,所有测试的方程都显示出不同种族群体的偏差:南亚患者的积极偏差和黑人患者的负偏差.
- 白人患者在所有被研究的方程中都表现出积极的偏差.
- 在10%到28%的患者中,根据所使用的方程,他们的CKD阶段分类发生了变化,偏差因年龄和方程类型而异.
结论:
- 证实了MDRD方程对南亚人高估eGFR,对黑人患者低估eGFR的先前发现,在替代方程中观察到类似的偏差.
- 观察到的偏见可能会导致英国少数民族患者体验的健康不平等.
- 新的无种族方程的广泛采用可能会导致英国26万到73万名CKD患者的重新分类,这将对二级护理服务产生重大影响.
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