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Pathology, lab organizations endorse use of CKD-EPI 2021 race-free equations

March 2022—The CAP was one of eight pathology and laboratory organizations to endorse in a joint statement the use of the CKD-EPI 2021 race-free equations for calculating estimated glomerular filtration rate. The others are the Academy of Clinical Laboratory Physicians and Scientists, American Association of Clinical Chemistry, American Society for Clinical Pathology, Association of Pathology Chairs, Clinical Laboratory Management Association, National Independent Laboratory Association, and Society of American Federated Medical Laboratory Scientists (the views of the SAFMLS do not represent the views of the U.S. government). Following is the statement they released on Jan. 31.

Serum creatinine with estimated glomerular filtration rate (eGFRcr) is frequently measured and reported by United States clinical laboratories. This test is included in the basic metabolic, comprehensive metabolic, and renal function panels, and the Kidney Profile.¹ The eGFRcr and urine albumin to creatinine ratio (uACR) are currently the primary tests used in clinical practice to assess kidney function, diagnose kidney disease, determine the severity of kidney disease, and monitor progression. The eGFRcr is also used to inform treatment decisions, including medication dosing, timing of referral to nephrology, and preparing for kidney replacement therapies.

More than 37 million adults in the U.S. have kidney disease. Of these, almost 90 percent are unaware that they have it. A disproportionate number of people living with kidney disease are from groups that routinely face health disparities and inequities in health care delivery, including Blacks or African Americans, Hispanics or Latinos, American Indians or Alaska Natives, Asian Americans, and Native Hawaiians or other Pacific Islanders.

The two equations most used to calculate eGFRcr in the United States, the Modification of Diet in Renal Disease (MDRD) Study and the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equations, include a race coefficient. As race is a subjective, social construct, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) established a task force in 2020 to reassess the inclusion of race in diagnosing kidney diseases in the United States. The NKF-ASN Task Force employed a holistic approach incorporating input from the medical community and patients to identify an approach that balanced social justice with scientific rigor.