A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease
Abstract
Background In response to a national call for re-evaluation of the use of race in clinical algorithms, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) established a Task Force to reassess inclusion of race in the estimation of glomerular filtration rate (GFR) in the United States and its implications for diagnosis and management of patients with, or at risk for, kidney diseases. Process & deliberations The Task Force organized its activities over 10 months in phases to (1) clarify the problem and evidence regarding GFR estimating equations in the United States (described previously in an interim report), and, in this final report, (2) evaluate approaches to address use of race in GFR estimation, and (3) provide recommendations. We identified 26 approaches for the estimation of GFR that did or did not consider race and narrowed our focus, by consensus, to 5 of those approaches. We holistically evaluated each approach considering 6 attributes: assay availability and standardization; implementation; population diversity in equation development; performance compared with measured GFR; consequences to clinical care, population tracking, and research; and patient centeredness. To arrive at a unifying approach to estimate GFR, we integrated information and evidence from many sources in assessing strengths and weaknesses in attributes for each approach, recognizing the number of Black and non-Black adults affected. Recommendations (1) For US adults (…
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The 2021 CKD-EPI equation calculates eGFR without regard to race.
“The American Society of Nephrology and National Kidney Foundation advocate using the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, which was generated without inclusion of a term for race and calculates eGFR without regard to race, to estimate glomerular filtration rate (GFR) from creatinine, age, and sex (20).”
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- Authors
- Delgado, C., Baweja, M., Crews, D. C., Eneanya, N. D., Gadegbeku, C. A., Inker, L. A., Mendu, M. L., Miller, W. G., Moxey-Mims, M. M., Roberts, G. V., St. Peter, W. L., Warfield, C., & Powe, N. R.
- Affiliations
- San Francisco VA Medical Center (US)
- Icahn School of Medicine at Mount Sinai (US)
- Johns Hopkins University (US)
- University of Pennsylvania (US)
- Cleveland Clinic (US)
- Tufts Medical Center (US)
- Brigham and Women's Hospital (US)
- Virginia Commonwealth University (US)
- University of Washington (US)
- National Kidney Foundation (US)
- San Francisco General Hospital (US)
- Corresponding author
- Delgado, Cynthia
- Powe, Neil R.
- ORCID
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2022-02
- Volume
- 79
- Issue
- 2
- Pages
- 268-288.e1
- ISSN
- 0272-6386 (ISSN-L)
- OpenAlex
- W3200821335
- Cited by
- 783
- References
- 7
- Citations by year
- 2026: 90 · 2025: 160 · 2024: 211 · 2023: 182 · 2022: 122 · 2021: 17
- FWCI
- 21.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Race, Genetics, and Society
- Keywords
- glomerular filtration rate estimation, chronic kidney disease diagnosis, cystatin C, Black people, patient-centeredness
- MeSH terms
- Adult, Creatinine, Glomerular Filtration Rate, Health Promotion, Humans, Kidney, Nephrology, United States, Renal Insufficiency, Chronic
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