Race and creatinine excretion in chronic renal insufficiency

Goldwasser, Philip; Aboul-Magd, Ahmed; Maru, Mahendra

doi:10.1016/s0272-6386(97)90559-x

Cited by 61 publications

(64 citation statements)

References 8 publications

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“…A similar pattern was not observed for creatinine, which exhibited higher values for non-Hispanic blacks versus whites regardless of age. This inconsistency reflects prior reports of higher muscle mass and creatinine production in non-Hispanic blacks (26,(38)(39)(40). Our data also show that being Mexican American was associated with lower serum concentrations of bTP and b2M across all ages.…”

Section: Discussionsupporting

confidence: 80%

Comparison of Serum Concentrations of β-Trace Protein, β2-Microglobulin, Cystatin C, and Creatinine in the US Population

Juraschek

Coresh

Inker

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives b-trace protein (bTP), b2-microglobulin (b2M), and cystatin C (CysC) have advantages over creatinine for estimating GFR and prognosis. This study compares the distribution of all four markers in the general population and their associations with possible determinants of GFR.Design, setting, participants, & measurements bTP and b2M were measured in 7596 participants (aged $12 years) of the Third National Health and Nutrition Examination Survey (1988)(1989)(1990)(1991)(1992)(1993)(1994). bTP and b2M concentrations and the proportion of persons with elevated ($99th percentile for young healthy participants) bTP ($0.81 mg/L), b2M ($2.80 mg/L), standardized CysC ($1.03 mg/L), and creatinine ($1.2 mg/dl for men and $1.0 mg/dl for women) were compared across demographic and clinical factors.Results Elevated bTP, b2M, and CysC showed stronger associations with age than elevated serum creatinine, the prevalence of elevated levels reaching 47%, 44%, 58%, and 26%, respectively, by age 80 years. bTP, CysC, and creatinine were higher in men but b2M was not associated with sex. Mexican Americans had lower bTP, b2M, CysC, and creatinine compared with non-Hispanic whites. Hypertension and higher C-reactive protein were associated with elevations in all markers, whereas non-Hispanic black race, body mass index, diabetes, smoking status, triglycerides, HDL cholesterol, and education were not associated in a consistent manner across the different markers.Conclusions bTP, b2M, CysC, and creatinine differ in their associations with demographic and clinical factors, suggesting variation in their non-GFR determinants. Future studies should examine these markers with measured GFR to determine their diagnostic and prognostic utility.

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Section: Discussionsupporting

confidence: 80%

Comparison of Serum Concentrations of β-Trace Protein, β2-Microglobulin, Cystatin C, and Creatinine in the US Population

Juraschek

Coresh

Inker

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…This is the case for the well known Cockcroft and Gault equation (3,7,(13)(14)(15). In 1999, the Modification of Diet in Renal Disease (MDRD) study equation has been published and an ethnic correction factor has been proposed for African Americans (8).…”

Section: Introductionmentioning

confidence: 91%

“…The most important limitation is linked to the fact that serum creatinine concentration is dependent not only on GFR but also on muscular mass. Because of this strong link to muscular mass, serum creatinine concentration and creatinine excretion will vary with ethnicity, gender, and age independently of any GFR changes (3)(4)(5)(6). For this reason, several creatinine-based equations have been developed, including these last two variables to estimate GFR (7,8).…”

Section: Introductionmentioning

confidence: 99%

“…From the same view, serum creatinine concentration will differ between ethnicities for the same GFR level because it is well known that African people proportionally have a larger muscular mass than Caucasian or Asian populations (9 -11). At the same GFR, serum creatinine concentrations are higher in black populations not only because of higher muscular mass but also because creatinine tubular secretion could be a variable according to ethnicity (3)(4)(5). Moreover, in the black ethnicity, serum creatinine also reflects the risk of developing chronic kidney disease (CKD) (12).…”

Section: Introductionmentioning

confidence: 99%

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Are the Creatinine-Based Equations Accurate to Estimate Glomerular Filtration Rate in African American Populations?

Delanaye

Mariat²,

Maillard³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryRegarding the high prevalence of African American patients with ESRD, it is important to estimate the prevalence of early stages of chronic kidney disease in this specific population. Because serum creatinine concentration is dependent on muscular mass, an ethnic factor has to be applied to creatinine-based equations. Such ethnic factors have been proposed in the Modification of Diet in Renal Disease (MDRD) study equation and in the more recent Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. This review analyzes how these correction factors have been developed and how they have, or have not, been validated in external populations. It will be demonstrated that the African American factor in the MDRD study equation is accurate in African American chronic kidney disease (CKD) patients. However, it will be shown that this factor is probably too high for subjects with a GFR of >60 ml/min per 1.73 m 2 , leading to an underestimation of the prevalence of CKD in the global African American population. It will also be confirmed that this ethnic factor is not accurate in African (non-American) subjects. Lastly, the lack of true external validation of the new CKD-EPI equations will be discussed. Additional trials seem necessary in American African and African populations to better estimate GFR and apprehend the true prevalence of CKD in this population with a high renal risk.

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“…Furthermore, health care professionals may refer blacks earlier because of their high prevalence of diabetes mellitus as underlying kidney disease or comorbidity (42,43). Additionally, it is possible that health care workers do not take into account that blacks have a higher creatinine production than whites due to differences in muscle mass, metabolism, and tubular handling of creatinine (44)(45)(46). The different association of creatinine and eGFR in blacks and whites is reflected in the MDRD equation by the multiplicative 1.212 term (21).…”

Section: Discussionmentioning

confidence: 99%

Differences in Progression to ESRD between Black and White Patients Receiving Predialysis Care in a Universal Health Care System

Beukel

Goeij

Dekker

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Studies performed in the United States showed that blacks progress from CKD to ESRD faster than do whites. Possible explanations are differences in health care system factors. This study investigated whether progression is also faster in a universal health care system, where all patients receive comparable care.Design, setting, participants, & measurements Data from the PREdialysis PAtient REcord study, a multicenter follow-up study of patients with CKD who started predialysis care in The Netherlands (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011), were analyzed. Time-dependent Cox proportional hazards models were used to estimate the hazard ratio (HR) for starting renal replacement therapy (RRT), and linear mixed models were used to compare renal function decline (RFD) between blacks and whites. To explore possible mechanisms, analyses were adjusted for patient characteristics.Results At initiation of predialysis care, blacks (n=49) were younger and had more diabetes mellitus, higher proteinuria levels, and a higher estimated GFR than whites (n=946). Median follow-up time in months was similar (blacks: 13.9 [boundaries of interquartile range (IQR), 5.3 to 19.5]; whites: 13.1 [IQR, 5.1 to 24.0]). For blacks compared with whites, the crude HR for starting RRT within the first 15 months was 0.86 (95% confidence interval [CI], 0.55 to 1.34) and from 15 months onward, 1.93 (95% CI, 1.02 to 3.68), which increased after adjustment. RFD was faster by 0.18 (95% CI, 0.05 to 0.32) ml/min per 1.73 m 2 per month in blacks compared with whites.Conclusion Blacks receiving predialysis care in a universal health care system have faster disease progression than whites, suggesting that health care system factors have a less influential role than had been thought in explaining black-white differences.

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Race and creatinine excretion in chronic renal insufficiency

Cited by 61 publications

References 8 publications

Comparison of Serum Concentrations of β-Trace Protein, β2-Microglobulin, Cystatin C, and Creatinine in the US Population

Comparison of Serum Concentrations of β-Trace Protein, β2-Microglobulin, Cystatin C, and Creatinine in the US Population

Are the Creatinine-Based Equations Accurate to Estimate Glomerular Filtration Rate in African American Populations?

Differences in Progression to ESRD between Black and White Patients Receiving Predialysis Care in a Universal Health Care System

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