Impact of Removing Race Variable on CKD Classification Using the Creatinine-Based 2021 CKD-EPI Equation

Letter to the Editor of Kidney Medicine Journal

Jasleen K. Ghuman, MD, Junyan Shi, MSc, PhD, Leila R. Zelnick, PhD, Andrew N. Hoofnagle, MD, PhD,6 Rajnish Mehrotra, MD, MS, and Nisha Bansal, MD, MAS

To the Editor,

In 2020, the University of Washington (UW) removed the race coefficient (Black vs non-Black race) from the 2009 Chronic Kidney Disease Epidemiology Collaboration (2009 CKD-EPIno race) estimated glomerular filtration rate (eGFR) equation in a step toward acknowledging that race is a social and not a biologic construct.

Recently, a new eGFR equation, the 2021 Chronic Kidney Disease Epidemiology Collaboration (2021 CKD-EPI) equation, was published, in which the race variable was removed and the coefficients for the other variables (age, sex, and serum creatinine) were recalibrated.1 Subsequently, the National Kidney Foundation and American Society of Nephrology Task Force recommended that the 2021 CKD-EPI equation be implemented for eGFR reporting.2 In these analyses, we examined the effect of the creatinine-based 2021 CKD-EPI and 2009 CKD-EPIno race equations on reclassification of chronic kidney disease stages compared with the 2009 CKD-EPI equation at our institution (UW) and among participants in the National Health and Nutrition Examination Survey (NHANES) to understand the impact of the new eGFR equations in “real-world” populations.

Read the complete letter to the Editor