A New Panel-Estimated GFR, Including β2-Microglobulin and β-Trace Protein and Not Including Race, Developed in a Diverse Population
Bibliographic record
Abstract
Rationale and Objective Glomerular filtration rate (GFR) estimation based on creatinine and cystatin C (eGFR cr-cys ) is more accurate than estimated GFR (eGFR) based on creatinine or cystatin C alone (eGFR cr or eGFR cys , respectively), but the inclusion of creatinine in eGFR cr-cys requires specification of a person's race. β 2 -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 [ 51 Cr]EDTA. Results Mean measured GFRs were 58.1 and 83.2 mL/min/1.73 m 2 , 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 eGFR cys (percentage of estimates greater than 30% different from measured GFR [1 − P 30 ] of 15.6% vs 17.4%; P = 0.01), and the 4-marker panel without race was as accurate as eGFR cr-cys (1 − P 30 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 eGFR cr-cys without requiring specification of race. A more accurate race-free eGFR could be an important advance.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".