Importance At a given estimated glomerular filtration rate (eGFR), individuals who are Black have higher rates of mortality and kidney failure with replacement therapy (KFRT) compared with those who are non-Black. Whether the recently adopted eGFR equations without race preserve racial differences in risk of mortality and KFRT at a given eGFR is unknown. Objective To assess whether eGFR equations with and without race and cystatin C document racial differences in risk of KFRT and mortality in populations including Black and non-Black participants. Design, Setting, and Participants Retrospective individual-level data analysis of 62 011 participants from 5 general population and 3 chronic kidney disease (CKD) US-based cohorts with serum creatinine, cystatin C, and follow-up for KFRT and mortality from 1988 to 2018. Exposures Chronic Kidney Disease Epidemiology Collaboration equation with serum creatinine (eGFRcr with and without race), cystatin C (eGFRcys without race), or both markers (eGFRcr-cys without race). Main Outcomes and Measures The prevalence of decreased eGFR at baseline and hazard ratios of KFRT and mortality in Black vs non-Black participants were calculated, adjusted for age and sex. Analyses were performed within each cohort and with random-effect meta-analyses of the models. Results Among 62 011 participants (20 773 Black and 41 238 non-Black; mean age, 63 years; 53% women), the prevalence ratio (95% CI; percent prevalences) of eGFR less than 60 mL/min/1.73 m2 comparing Black with non-Black participants was 0.98 (95% CI, 0.93-1.03; 11% vs 12%) for eGFRcr with race, 0.95 (95% CI, 0.91-0.98; 17% vs 18%) for eGFRcys, and 1.2 (95% CI, 1.2-1.3; 13% vs 11%) for eGFRcr-cys but was 1.8 (95% CI, 1.7-1.8; 15% vs 9%) for eGFRcr without race. During a mean follow-up of 13 years, 8% and 4% of Black and non-Black participants experienced KFRT and 34% and 39% died, respectively. Decreased eGFR was associated with significantly greater risk of both outcomes for all equations. At an eGFR of 60 mL/min/1.73 m2, the hazard ratios for KFRT comparing Black with non-Black participants were 2.8 (95% CI, 1.6-4.9) for eGFRcr with race, 3.0 (95% CI, 1.5-5.8) for eGFRcys, and 2.8 (95% CI, 1.4-5.4) for eGFRcr-cys vs 1.3 (95% CI, 0.8-2.1) for eGFRcr without race. The 5-year absolute risk differences for KFRT comparing Black with non-Black participants were 1.4% (95% CI, 0.2%-2.6%) for eGFRcr with race, 1.1% (95% CI, 0.2%-1.9%) for eGFRcys, and 1.3% (95% CI, 0%-2.6%) for eGFRcr-cys vs 0.37% (95% CI, -0.32% to 1.05%) for eGFRcr without race. Similar patterns were observed for mortality. Conclusions and Relevance In this retrospective analysis of 8 US cohorts including Black and non-Black individuals, the eGFR equation without race that included creatinine and cystatin C, but not the eGFR equation without race that included creatinine without cystatin C, demonstrated racial differences in the risk of KFRT and mortality throughout the range of eGFR. The eGFRcr-cys equation may be preferable to the eGFRcr equation without race for assessing racial differences in the risk of KFRT and mortality associated with low eGFR.

中文翻译：

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使用无种族方程计算的估计 GFR 与黑人与非黑人种族肾衰竭和死亡率之间的关联。

重要性 在给定的估计肾小球滤过率 (eGFR) 下，与非黑人相比，黑人在替代疗法 (KFRT) 下的死亡率和肾衰竭率更高。最近采用的不考虑种族的 eGFR 方程是否保留给定 eGFR 下死亡率和 KFRT 风险的种族差异尚不清楚。目的 评估包含或不包含种族和半胱氨酸蛋白酶抑制剂 C 的 eGFR 方程是否记录了包括黑人和非黑人参与者在内的人群中 KFRT 风险和死亡率的种族差异。设计、设置和参与者 对来自 5 个普通人群和 3 个美国慢性肾病 (CKD) 队列的 62 011 名参与者进行回顾性个人水平数据分析，包括血清肌酐、半胱氨酸蛋白酶抑制剂 C，以及 1988 年至 1988 年间 KFRT 和死亡率的随访。 2018. 暴露慢性肾脏病流行病学与血清肌酐（有和无种族的 eGFRcr）、半胱氨酸蛋白酶抑制剂 C（无种族的 eGFRcys）或两者标记物（无种族的 eGFRcr-cys）的协作方程。主要结果和措施 计算了黑人与非黑人参与者中基线 eGFR 下降的发生率以及 KFRT 和死亡率的风险比，并根据年龄和性别进行了调整。在每个队列中进行分析，并对模型进行随机效应荟萃分析。结果 在 62 011 名参与者（20 773 名黑人和 41 238 名非黑人；平均年龄 63 岁；53% 女性）中，eGFR 低于 60 mL/min/1.73 m2 的患病率（95% CI；患病率百分比）比较黑人与非黑人参与者的 eGFRcr 与种族的比值为 0.98（95% CI，0.93-1.03；11% vs 12%），eGFRcys 的比值为 0.95（95% CI，0.91-0.98；17% vs 18%），eGFRcys 的比值为 1.2（ eGFRcr-cys 的 95% CI，1.2-1.3；13% vs 11%），但无种族 eGFRcr 的值为 1.8（95% CI，1.7-1.8；15% vs 9%）。在平均 13 年的随访期间，8% 和 4% 的黑人和非黑人参与者经历了 KFRT，分别有 34% 和 39% 的人死亡。对于所有方程，eGFR 降低均与两种结果的风险显着增加相关。在 eGFR 为 60 mL/min/1.73 m2 时，黑人与非黑人参与者的 KFRT 风险比为 2.8（95% CI，1.6-4.9），种族 eGFRcr 为 3.0（95% CI，1.5-5.8） eGFRcys 为 2.8（95% CI，1.4-5.4），eGFRcr-cys 为 2.8（95% CI，1.4-5.4），而无种族 eGFRcr 为 1.3（95% CI，0.8-2.1）。比较黑人与非黑人参与者的 KFRT 5 年绝对风险差异，eGFRcr 与种族的差异为 1.4%（95% CI，0.2%-2.6%），eGFRcys 的差异为 1.1%（95% CI，0.2%-1.9%） ，eGFRcr-cys 为 1.3%（95% CI，0%-2.6%），而无种族 eGFRcr 为 0.37%（95% CI，-0.32% 至 1.05%）。死亡率也观察到类似的模式。结论和相关性 在这项对包括黑人和非黑人在内的 8 个美国队列的回顾性分析中，不考虑种族的 eGFR 方程（包含肌酐和胱抑素 C），但不考虑种族的 eGFR 方程（包含肌酐但不含胱抑素 C），证明了种族差异在整个 eGFR 范围内 KFRT 和死亡率的风险。