Screening for chronic kidney disease complications in US adults: racial implications of a single GFR threshold.
OBJECTIVE
An ideal and effective screening tool should perform equally across ethnic groups. The objective of this study was to determine whether the widely advocated creatinine-based estimated GFR (eGFR) threshold of 60 ml/min per 1.73 m(2) identifies the typical metabolic abnormalities related to chronic kidney disease equally well in minority and nonminority adults.


METHODS
This objective was addressed using data for 8918 minority and nonminority adult participants in the National Health and Nutrition Examination Survey 2003 through 2006, which used stratified, multistage, probability sampling methods to assemble a nationwide probability sample of the noninstitutionalized population of the United States. Metabolic abnormalities including BP, potassium, hemoglobin, bicarbonate, uric acid, calcium, phosphorus, and parathyroid hormone were defined by fifth or 95th percentile values.


RESULTS
Among participants with eGFR <60 ml/min per 1.73 m(2), black individuals were more likely than white individuals to have low hemoglobin (adjusted odds ratio [aOR] 3.76; 95% confidence interval [CI] 1.94 to 7.28), elevated uric acid (aOR 2.15; 95% CI 1.26 to 3.68), and elevated parathyroid hormone (aOR 3.93; 95% CI 2.33 to 6.66).


CONCLUSIONS
Metabolic consequences of reduced eGFR are more common in black individuals and seem to be present at levels well above 60 ml/min per 1.73 m(2); thus, black individuals should be screened for the metabolic complications of chronic kidney at higher GFR levels.
Ibrahim
Hassan N
HN
Department of Medicine, University of Minnesota, USA.
Wang
Changchun
C
Ishani
Areef
A
Collins
Allan J
AJ
Foley
Robert N
RN
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005919:Glomerular Filtration Rate; D006306:Health Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology / Q000378:metabolism / Q000503:physiopathology; D008403:Mass Screening / Q000379:methods*; D008954:Models, Biological; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D014481:United States; D044465:White People / Q000706:statistics & numerical data
D015415:Biomarkers; D003404:Creatinine
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