Table 1
Baseline characteristics by ethnic origin.
| MEAN (SD) | OVERALL (n = 21,617) | NON-CORRECTED GROUP (n = 15,127) | AFRICAN SURINAMESE (n = 4,151) | GHANAIAN (n = 2,339) | P-VALUE |
|---|---|---|---|---|---|
| Age, years | 44 (13) | 43 (13) | 48 (13)* | 45 (11)*† | <0.001 |
| <50 (%) | 13,086 (60.5) | 9,705 (64.2) | 1,964 (47.3)* | 1,417 (60.6)*† | <0.001 |
| 50–69 (%) | 8,443 (39.1) | 5,361 (35.4) | 2,161 (52.1)* | 921 (39.4)*† | <0.001 |
| ≥70 (%) | 88 (0.4) | 61 (0.4) | 26 (0.6) | 1.0 (0.0)† | 0.005 |
| Male sex (%) | 9,129 (42) | 6,608 (44) | 1,616 (39)* | 905 (39)* | <0.001 |
| BMI, kg/m2 | 27.1 (5.0) | 26.7 (5.2) | 27.8 (5.5)* | 28.5 (5.0)*† | <0.001 |
| ACR, median [IQR], mg/mmol | 0.28 [0.17–0.54] | 0.29 [0.17–0.54] | 0.26 [0.16–0.52] | 0.25 [0.15–0.53] | 0.790 |
| Albuminuria ≥3 mg/mmol (%) | 2,284 (10.6) | 1,565 (10.3) | 452 (10.9) | 267 (11.4) | 0.239 |
| Smoking (%) | 5,168 (24) | 3,755 (25) | 1,309 (32)* | 104 (4.4)*† | <0.001 |
| Diabetes (%) | 2,334 (11) | 1,568 (10) | 494 (12)* | 272 (12) | 0.016 |
| Hypertension (%) | 7,046 (33) | 3,913 (26) | 1,905 (46) * | 1,228 (53) *† | <0.001 |
| Systolic BP, mmHg | 127 (17) | 128 (18) | 125 (18)* | 127 (18)† | <0.001 |
| Total cholesterol, mmol/L | 4.9 (1.0) | 4.9 (1.0) | 4.9 (1.0) | 4.9 (1.0) | <0.001 |
| HDL-cholesterol, mmol/L | 1.4 (0.4) | 1.4 (0.4) | 1.5 (0.4)* | 1.6 (0.4)*† | <0.001 |
| Non-HDL, mmol/L | 3.5 (1.0) | 3.5 (1.0) | 3.4 (1.0)* | 3.3 (1.0)* | <0.001 |
| Hypercholesterolemia (%) | 2,210 (10) | 1,563 (10) | 402 (9.7) | 245 (11) | 0.040 |
| CVD history (%) | 3,394 (16) | 2,401 (16) | 663 (16) | 330 (14)* | 0.027 |
| Angina pectoris (%) | 1,326 (6.1) | 978 (6.5) | 230 (5.5) | 118 (5.0) | 0.016 |
| Claudication (%) | 193 (0.9) | 115 (0.8) | 42 (1.0) | 36 (2.0)* | 0.001 |
| Possible infarction (%) | 1,858 (8.6) | 1,348 (8.9) | 351 (8.5) | 159 (7.0)* | 0.014 |
| Cerebrovascular (%) | 1,119 (5.2) | 763 (5.0) | 261 (6.3)* | 95 (4.1)† | <0.001 |
| Level of education | |||||
| None or elementary (%) | 3,818 (18) | 2,927 (19) | 231 (5.6) * | 660 (28)*† | <0.001 |
[i] Note: Values for categorical variables are given as a number (percentage); for continuous variables as mean (standard deviation). Non-corrected group includes participants of Dutch, South-Asian Surinamese, Turkish, and Moroccan origin, where application of a race coefficient is not advised.
Abbreviations: ACR, urinary albumin-to-creatinine ratio; BMI, body mass index; BP, blood pressure; CVD history, history of cardiovascular disease (i.e., claudication intermittens, angina pectoris, myocardial infarction, and cerebrovascular accident); HDL, high-density lipoprotein; IQR, interquartile range.
Post hoc analysis: *P < 0.001 vs. non-corrected; †P < 0.001 vs. African Surinamese.
Table 2
eGFR and CKD prevalence by equation by ethnic group.
| 2009 CKD-EPI | 2009 CKD-EPI WITHOUT RACE CORRECTION | 2021 CKD-EPI | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OVERALL | NON-CORRECTED | AFRICAN SURINAMESE | GHANAIAN | P-VALUE | OVERALL | NON-CORRECTED | AFRICAN SURINAMESE | GHANAIAN | P-VALUE | OVERALL | NON-CORRECTED | AFRICAN SURINAMESE | GHANAIAN | P-VALUE | |
| eGFR estimates, mL/min/1.73 m2 | 102 (18) | 102 (17) | 103 (19) | 104 (20)*† | <0.001 | 98 (18)‡ | NA | 89 (17)*‡ | 90 (17)*†‡ | <0.001 | 101 (17)‡ | 104 (16)‡ | 92 (16)*‡ | 93 (17)*‡ | <0.001 |
| eGFR <60 mL/min/1.73 m2, n (%) | 275 (1.2) | 176 (1.2) | 56 (1.3) | 32 (1.4) | 0.249 | 429 (1.9)‡ | NA | 147 (3.5)*‡ | 95 (4.1)*‡ | <0.001 | 297 (1.3)‡ | 125 (0.8)‡ | 97 (2.3)*‡ | 67 (2.9)*‡ | <0.001 |
| CKD, n (%) | 2,335 (10.5) | 1,565 (10.3) | 452 (10.9) | 267 (11.4) | 0.239 | 2,460 (11.1)‡ | NA | 523 (12.6)*‡ | 321 (13.7)*‡ | <0.001 | 2,351 (10.6)‡ | 1,526 (10.1)‡ | 480 (11.6)‡* | 295 (12.6)‡* | <0.001 |
[i] Note: Values for categorical variables are given as number (percentage); for continuous variables as mean (SD/standard deviation).
Abbreviations: CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate.
Post hoc analysis: *P < 0.001 vs. non-corrected group; †P < 0.001 vs. African Surinamese; ‡P < 0.001 vs. 2009 CKD-EPI.
Figure 1
Internal consistency between CKD-EPI 2009 and 2021 in detecting CKD (y/n) per ethnic group.
Note: Excellent internal consistency of CKD between the 2009 CKD-EPI equation and the 2021 CKD-EPI equation.
Abbreviations: CKD, chronic kidney disease; n, no; y, yes.
Figure 2
C-statistic per ethnic group per equation for detecting CKD with the traditional screening approach.*
Note: C-statistics with 95% confidence interval (CI). Dotted line at 0.5: low diagnostic accuracy. Dotted line at 0.8: moderate diagnostic accuracy. Dotted line at 0.9: excellent diagnostic accuracy.
No significant differences were found.
Abbreviations: CKD, chronic kidney disease; uc, uncorrected.
*Screening participants with hypertension, diabetes mellitus, and/or cardiovascular (CV) history.
Table 3
Risk scores according to SCORE2, SCORE2 Add-on eGFR <60 mL/min/1.73 m2, SCORE2 Add-on CKD.
| OVERALL (n = 18,833) | NON-CORRECTEDGROUP (n = 12,691) | AFRICAN SURINAMESE (n = 3,425) | GHANAIAN (n = 2,265) | P-VALUE | |
|---|---|---|---|---|---|
| SCORE2 | 0.93 (0.29–2.34) | 0.90 (0.27–2.36) | 1.24 (0.42–2.89)* | 0.67 (0.24–1.55)*† | <0.001 |
| <50 years | 0.39 (0.15–0.96) | 0.41 (0.14–1.02) | 0.41 (0.17–0.95) | 0.31 (0.14–0.65)*† | <0.001 |
| 50–69 years | 2.44 (1.37–4.16) | 2.66 (1.51–4.46) | 2.49 (1.35–4.14)* | 1.66 (0.97–2.66)*† | <0.001 |
| SCORE2 + eGFR <60 mL/min/1.73 m2 2009 | 0.93 (0.29–2.35) | 0.90 (0.27–2.37) | 1.24 (0.42–2.90)* | 0.67 (0.24–1.57)*† | <0.001 |
| <50 years | 0.39 (0.15–0.96) | 0.41 (0.14–1.02) | 0.41 (0.17–0.96) | 0.31 (0.14–0.65)*† | <0.001 |
| 50–69 years | 2.45 (1.38–4.19) | 2.66 (1.51–4.51) | 2.50 (1.35–4.19)* | 1.67 (0.97–2.67)*† | <0.001 |
| SCORE2 + eGFR<60 mL/min/1.73 m2 2021 | 0.93 (0.29–2.35) | 0.91 (0.27–2.37)‡ | 1.24 (0.42–2.91)*‡ | 0.67 (0.24–1.58)*†‡ | <0.001 |
| <50 years | 0.39 (0.15–0.96) | 0.41 (0.14–1.02) | 0.41 (0.17–0.96) | 0.31 (0.14–0.65)*† | <0.001 |
| 50–69 years | 2.46 (1.38–4.19) | 2.66 (1.51–4.50) | 2.50 (1.35–4.21)* | 1.68 (0.98–2.70)*† | <0.001 |
| SCORE2 + CKD 2009 | 0.95 (0.30–2.39) | 0.92 (0.28–2.40) | 1.26 (0.43–2.97)* | 0.68 (0.25–1.60)*† | <0.001 |
| <50 years | 0.40 (0.15–0.98) | 0.42 (0.15–1.04) | 0.41 (0.17–0.97) | 0.32 (0.14–0.65)*† | <0.001 |
| 50–69 years | 2.50 (1.41–4.27) | 2.69 (1.54–4.59) | 2.54 (1.39–4.29)* | 1.69 (0.98–2.72)*† | <0.001 |
| SCORE2 + CKD 2021 | 0.95 (0.30–2.39) | 0.92 (0.28–2.40)‡ | 1.26 (0.43–2.98)*‡ | 0.68 (0.25–1.61)*†‡ | <0.001 |
| <50 years | 0.40 (0.15–0.98) | 0.42 (0.15–1.04) | 0.41 (0.17–0.97) | 0.32 (0.14–0.65)*† | <0.001 |
| 50–69 years | 2.50 (1.41–4.27) | 2.69 (1.54–4.58) | 2.54 (1.39–4.30)* | 1.71 (0.98–2.73)*† | <0.001 |
[i] Note: Median scores (IQR) for SCORE2, SCORE2 with add-on eGFR <60 mL/min/1.73 m2, and SCORE2 with add-on CKD, stratified by ethnicity and age group.
Abbreviations: CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; IQR, interquartile range.
Post hoc analysis: *P < 0.001 vs, non-corrected; †P < 0.001 vs. African Surinamese; ‡P < 0.001 vs. 2009 CKD-EPI.
Table 4
Risk groups according to SCORE2 Add-on eGFR <60 mL/min/1.73 m2 and CKD by CKD-EPI 2009 and 2021.
| N (%) | OVERALL (n = 18,833) | NON-CORRECTEDGROUP (n = 12,691) | AFRICAN SURINAMESE (n = 3,425) | GHANAIAN (n = 2,265) | P-VALUE |
|---|---|---|---|---|---|
| SCORE2, <50 years | |||||
| Low to moderate (<2.5%) | 10,671 (79.9) | 7,605 (78.4) | 1,536 (78.2) | 1,332 (94)*† | <0.001 |
| High (2.5% to <7.5%) | 688 (5.2) | 552 (5.7) | 95 (4.8) | 23 (1.6)*† | <0.001 |
| Very high (≥7.5%) | 20 (0.1) | 19 (0.2) | – | – | 0.061 |
| SCORE2, 50–69 years | |||||
| Low to moderate (<5%) | 6,116 (70.1) | 3,578 (66.7) | 1,477 (68.3) | 862 (93.6)*† | <0.001 |
| High (5 to <10%) | 1,118 (12.8) | 782 (14.6) | 266 (12.3)* | 43 (4.7)*† | <0.001 |
| Very high (≥10) | 143 (1.6) | 104 (1.9) | 28 (1.3) | 4 (0.4) | 0.460 |
| +eGFR <60 mL/min/1.73 m2 2009, <50 years | |||||
| Low to moderate (<2.5%) | 10,650 (79.8) | 7,593 (78.2) | 1,534 (78.1) | 1,326 (93.6)*† | <0.001 |
| High (2.5% to <7.5%) | 706 (5.3) | 562 (5.8) | 96 (4.3) | 26 (1.8)*† | <0.001 |
| Very high (≥7.5%) | 23 (0.2) | 21 (0.2) | 1.0 (0.1) | – | 0.054 |
| +eGFR <60 mL/min/1.73 m2 2009, 50–69 years | |||||
| Low to moderate (<5%) | 5,979 (68.5) | 3,497 (65.2) | 1,448 (67.0) | 840 (91.2)*† | <0.001 |
| High risk (5 to <10%) | 1,203 (13.8) | 823 (15.4) | 288 (13.3)* | 62 (6.7)*† | <0.001 |
| Very high (≥10) | 195 (2.2) | 144 (2.7) | 35 (1.6) | 7 (0.8) | 0.143 |
| + eGFR <60 mL/min/1.73 m2 2021, <50 years | |||||
| Low to moderate (<2.5%) | 10,641 (79.7)‡ | 7,596 (78.3)‡ | 1,528 (77.8)‡ | 1,320 (93.2)*†‡ | <0.001 |
| High (2.5% to <7.5%) | 715 (5.4)‡ | 559 (5.8)‡ | 102 (5.2)‡ | 35 (2.5)*†‡ | <0.001 |
| Very high (≥7.5%) | 23 (0.2)‡ | 21 (0.2)‡ | 1.0 (0.1) | – | 0.061 |
| + eGFR <60 mL/min/1.73 m2 2021, 50–69 years | |||||
| Low to moderate (<5%) | 5,960 (68.3)‡ | 3,523 (65.7)‡ | 1,429 (66.1)‡ | 812 (88.2)*†‡ | <0.001 |
| High risk (5 to <10%) | 1,227 (14.1)‡ | 809 (15.1)‡ | 301 (13.9)*‡ | 89 (9.7)*†‡ | <0.001 |
| Very high (≥10) | 190 (2.2)‡ | 132 (2.4)‡ | 41 (1.9)‡ | 8 (0.9)‡ | 0.207 |
| + CKD 2009, <50 years | |||||
| Low to moderate (<2.5%) | 9,653 (72.3) | 6,907 (71.2) | 1,391 (70.8) | 1,172 (82.7)*† | <0.001 |
| High (2.5% to <7.5%) | 1,638 (12.3) | 1,197 (12.3) | 228 (11.6) | 182 (12.8)*† | <0.001 |
| Very high (≥7.5%) | 88 (0.7) | 72 (0.7) | 12 (0.6) | 1.0 (0.1) | 0.054 |
| + CKD 2009, 50–69 years | |||||
| Low to moderate (<2.5%) | 5,458 (62.5) | 3,192 (59.5) | 1,309 (60.6) | 777 (84.4)*† | <0.001 |
| High (2.5% to <7.5%) | 1,591 (18.2) | 1,036 (19.3) | 394 (18.2)* | 119 (12.9)*† | <0.001 |
| Very high (≥10) | 328 (3.8) | 236 (4.4) | 68 (3.1) | 13 (1.4) | 0.402 |
| + CKD 2021, <50 years | |||||
| Low to moderate (<2.5%) | 9,646 (72.3)‡ | 6,909 (71.2)‡ | 1,388 (70.7)‡ | 1,166 (82.3)*†‡ | <0.001 |
| High (2.5% to <7.5%) | 1,645 (12.3)‡ | 1,195 (12.3)‡ | 231 (11.8)‡ | 188 (13.3)*†‡ | <0.001 |
| Very high (≥7.5%) | 88 (0.7)‡ | 72 (0.7)‡ | 12 (0.6)‡ | 1.0 (0.1)‡ | 0.054 |
| + CKD 2021, 50–69 years | |||||
| Low to moderate (<2.5%) | 5,446 (62.4)‡ | 3,213 (59.9)‡ | 1,297 (60.0)‡ | 755 (82.0)*†‡ | <0.001 |
| High (2.5% to <7.5%) | 1,607 (18.4)‡ | 1,023 (19.1)‡ | 402 (18.6)*‡ | 141 (15.3)*†‡ | <0.001 |
| Very high (≥10) | 324 (3.7)‡ | 228 (4.3)‡ | 72 (3.3)‡ | 13 (1.4)‡ | 0.426 |
[i] Note: Distribution of risk categories for SCORE2 algorithms by age group and ethnicity.
Abbreviations: CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate.
Post hoc analysis: *P < 0.001 vs. non-corrected; †P < 0.001 vs. African Surinamese; ‡P < 0.001 vs. 2009 CKD-EPI.