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A New Panel-Estimated GFR, Including β2-Microglobulin and β-Trace Protein and Not Including Race, Developed in a Diverse Population.

Publication ,  Journal Article
Inker, LA; Couture, SJ; Tighiouart, H; Abraham, AG; Beck, GJ; Feldman, HI; Greene, T; Gudnason, V; Karger, AB; Eckfeldt, JH; Kasiske, BL ...
Published in: Am J Kidney Dis
May 2021

RATIONALE AND OBJECTIVE: Glomerular filtration rate (GFR) estimation based on creatinine and cystatin C (eGFRcr-cys) is more accurate than estimated GFR (eGFR) based on creatinine or cystatin C alone (eGFRcr or eGFRcys, respectively), but the inclusion of creatinine in eGFRcr-cys requires specification of a person's race. β2-Microglobulin (B2M) and β-trace protein (BTP) are alternative filtration markers that appear to be less influenced by race than creatinine is. STUDY DESIGN: Study of diagnostic test accuracy. SETTING AND PARTICIPANTS: Development in a pooled population of 7 studies with 5,017 participants with and without chronic kidney disease. External validation in a pooled population of 7 other studies with 2,245 participants. TESTS COMPARED: Panel eGFR using B2M and BTP in addition to cystatin C (3-marker panel) or creatinine and cystatin C (4-marker panel) with and without age and sex or race. OUTCOMES: GFR measured as the urinary clearance of iothalamate, plasma clearance of iohexol, or plasma clearance of [51Cr]EDTA. RESULTS: Mean measured GFRs were 58.1 and 83.2 mL/min/1.73 m2, and the proportions of Black participants were 38.6% and 24.0%, in the development and validation populations, respectively. In development, addition of age and sex improved the performance of all equations compared with equations without age and sex, but addition of race did not further improve the performance. In validation, the 4-marker panels were more accurate than the 3-marker panels (P < 0.001). The 3-marker panel without race was more accurate than eGFRcys (percentage of estimates greater than 30% different from measured GFR [1 - P30] of 15.6% vs 17.4%; P = 0.01), and the 4-marker panel without race was as accurate as eGFRcr-cys (1 - P30 of 8.6% vs 9.4%; P = 0.2). Results were generally consistent across subgroups. LIMITATIONS: No representation of participants with severe comorbid illness and from geographic areas outside of North America and Europe. CONCLUSIONS: The 4-marker panel eGFR is as accurate as eGFRcr-cys without requiring specification of race. A more accurate race-free eGFR could be an important advance.

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Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

May 2021

Volume

77

Issue

5

Start / End Page

673 / 683.e1

Location

United States

Related Subject Headings

  • beta 2-Microglobulin
  • Young Adult
  • White People
  • Urology & Nephrology
  • Severity of Illness Index
  • Reproducibility of Results
  • Renal Insufficiency, Chronic
  • Middle Aged
  • Male
  • Lipocalins
 

Citation

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Inker, L. A., Couture, S. J., Tighiouart, H., Abraham, A. G., Beck, G. J., Feldman, H. I., … CKD-EPI GFR Collaborators, . (2021). A New Panel-Estimated GFR, Including β2-Microglobulin and β-Trace Protein and Not Including Race, Developed in a Diverse Population. Am J Kidney Dis, 77(5), 673-683.e1. https://doi.org/10.1053/j.ajkd.2020.11.005
Inker, Lesley A., Sara J. Couture, Hocine Tighiouart, Alison G. Abraham, Gerald J. Beck, Harold I. Feldman, Tom Greene, et al. “A New Panel-Estimated GFR, Including β2-Microglobulin and β-Trace Protein and Not Including Race, Developed in a Diverse Population.Am J Kidney Dis 77, no. 5 (May 2021): 673-683.e1. https://doi.org/10.1053/j.ajkd.2020.11.005.
Inker LA, Couture SJ, Tighiouart H, Abraham AG, Beck GJ, Feldman HI, et al. A New Panel-Estimated GFR, Including β2-Microglobulin and β-Trace Protein and Not Including Race, Developed in a Diverse Population. Am J Kidney Dis. 2021 May;77(5):673-683.e1.
Inker, Lesley A., et al. “A New Panel-Estimated GFR, Including β2-Microglobulin and β-Trace Protein and Not Including Race, Developed in a Diverse Population.Am J Kidney Dis, vol. 77, no. 5, May 2021, pp. 673-683.e1. Pubmed, doi:10.1053/j.ajkd.2020.11.005.
Inker LA, Couture SJ, Tighiouart H, Abraham AG, Beck GJ, Feldman HI, Greene T, Gudnason V, Karger AB, Eckfeldt JH, Kasiske BL, Mauer M, Navis G, Poggio ED, Rossing P, Shlipak MG, Levey AS, CKD-EPI GFR Collaborators. A New Panel-Estimated GFR, Including β2-Microglobulin and β-Trace Protein and Not Including Race, Developed in a Diverse Population. Am J Kidney Dis. 2021 May;77(5):673-683.e1.
Journal cover image

Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

May 2021

Volume

77

Issue

5

Start / End Page

673 / 683.e1

Location

United States

Related Subject Headings

  • beta 2-Microglobulin
  • Young Adult
  • White People
  • Urology & Nephrology
  • Severity of Illness Index
  • Reproducibility of Results
  • Renal Insufficiency, Chronic
  • Middle Aged
  • Male
  • Lipocalins