Removing Ethnicity from eGFR Equations: Rationale, Impact, and Remaining Questions
This review traces the evolution of creatinine-based eGFR equations from MDRD to CKD-EPI and examines the evidence and clinical rationale behind NICE's 2021 recommendation to drop ethnicity adjustment. While removing the coefficient addresses concerns about race-based medicine, the new CKD-EPI equation without ethnicity adjustment has not been validated outside North America. The change may reclassify some patients into different CKD stages, affecting treatment thresholds and referral pathways.
The original study
Removal of ethnicity adjustment for creatinine-based estimated glomerular filtration rate equations.
- Authors
- Gama R, Javeria Peracha, Kate Bramham, Cockwell P
- Journal
- Annals of clinical biochemistry
- Type
- Journal Article, Review
- PMID
- 36550595
Original abstract
Creatinine-based estimated glomerular filtration rate equations (eGFRcreatinine) are used to measure excretory kidney function in clinical practice. Despite inter and intra-patient variability, eGFRcreatinine has excellent clinical utility and provides the basis for the classification system for chronic kidney disease (CKD), for kidney function monitoring, treatment interventions and referral pathways. The 4-variable modification of diet in renal disease (MDRD) eGFRcreatinine equation was introduced in 2000 and recommended by the National Institute for Health and Care Excellence (NICE) in 2008. Subsequently, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFRcreatinine equation was introduced in 2009 and is more accurate than MDRD in patients with mild and moderate CKD. In 2014, NICE recommended that CKD-EPI eGFRcreatinine replace MDRD eGFRcreatinine in routine clinical practice across England. Both equations originally incorporated adjustments for age, gender and ethnicity. However, the evidence for ethnicity adjustment has been increasingly questioned, and in 2021 NICE recommended that kidney function should be estimated by CKD-EPI eGFRcreatinine without using ethnicity adjustment. Recently, a CKD-EPI equation has been presented without ethnicity adjustment; however, this has not been validated outside of North America and NICE continues to recommend CKD-EPI 2009. We review the status of eGFRcreatinine in clinical practice, including the limitations of eGFRcreatinine and the rationale for removal of ethnicity adjustment and the potential impact of this change on clinical care for patients with kidney disease.