A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease

Abstract

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An overview of renal insufficiency, race, and glomerular filtration rate calculation for the vascular surgeon

“…The National Kidney Foundation and American Society of Nephrology task force's newly released recommendation is to use the CKD-EPI equation without the race variable, to increase use of cystatin C, and to encourage research into other more precise ways to measure GFR. 17 As institutions make this change, vascular surgeons should make decisions together with patients in situations where a racial coefficient-based eGFR might affect clinical treatment. This may be applicable in many situations that a vascular surgeon encountersd from use of contrast media or dosing medications to calculating preoperative risk.…”

The Glomerular Filtration Rate: From the Diagnosis of Kidney Function to a Public Health Tool

“…In September 2021, the National Kidney Foundation and the American Society of Nephrology Joint Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases recommended a new 2021 CKD-EPI creatinine eGFR equation which does not include race to estimate GFR ( Table 1 ). They recommend for the United States immediate implementation of the CKD-EPI creatinine equation refit without the race variable in all laboratories, and to facilitate increased, routine and timely use of cystatin C, as combining creatinine and cystatin C is more accurate ( 43 ).…”

Staying on track to achieve racial justice in kidney care

“… Key advances The nephrology community is leading by example to address harms of racialized medical practices in clinical algorithms by removing the long-standing inclusion of a Black race modifier in equations to estimate kidney function in patients 7 . Efforts to ensure equitable access to transplantation and equitable outcomes for all transplant patients will remain unrealized unless we acknowledge and counter systemic, institutional and interpersonal racism 6 , 8 .…”

“…The nephrology community is leading by example to address harms of racialized medical practices in clinical algorithms by removing the long-standing inclusion of a Black race modifier in equations to estimate kidney function in patients 7 .…”

“…The harms of this race-based medical practice were found to include a lower detection of chronic kidney disease (CKD) among individuals racialized as Black with a disproportionate burden of rapidly progressive CKD and kidney failure, lower provision of interventions for CKD management, late nephrology referral, and slower access to kidney transplant waiting lists by a median of 1.9 years 5 , 6 . After several months of systematic deliberation, including the rigorous assessment of 26 approaches for estimating glomerular filtration rate, the taskforce provided unequivocal guidance that CKD Epidemiology Collaboration (CKD-EPI) equations based on serum creatinine levels should be implemented across all US laboratories without a race modifier 7 . The taskforce also recommended that access to cystatin C measurements should be expanded for the purpose of confirming kidney function estimates among individuals at risk of CKD.…”