Projected Effect of Switching from the CKD-EPI 2009 to the CKD-EPI 2021 eGFR Equation in a Canadian Hospital
Date:
Background: Screening programs for chronic kidney disease (CKD) have used creatinine- based equations to estimate glomerular filtration rate (eGFR). A black race modifier was incorporated into the CKD-EPI 2009 equation whereas it was removed in the 2021 equation. In Canada, there is limited collection of race or ethnicity data for healthcare purposes due, in part, to the Canadian Human Rights Act which prohibits discrimination on numerous grounds including race. In many Canadian hospitals, the 2009 eGFR equation was implemented without using the race modifier. In this study, we estimated the effect of switching from the 2009 equation (calculated without race) to the new race independent 2021 CKD-EPI equation on the classification of CKD stages.
Methods: Participant creatinine, age and sex results from the CDC-NHANES 2017-18 dataset were used to calculate eGFR using the 2009 CKD-EPI equation (without race modifier) and the 2021 CKD-EPI equation. The impact of the two equations on the KDIGO-CKD stage categorization was assessed according to age and sex.
Results: A total of 550/4917 (11.2%) eGFR results were predicted to be < 60 ml/min/1.73m2 (female 275/2552 (10.8%); male 275/2365 (11.6%)) with the 2009 equation. In contrast, eGFR results < 60 ml/min/1.73m2 decreased to 443/4917 (9.0%) (female 224/2552 (8.8%); male 219/2365 (9.3%)) with the 2021 equation. The difference between the two equations was greatest for older individuals (6.4 % decrease 70-79 year age group; 2.6% decrease 30-39 year age group). Conclusions: An overall 2.2% decrease in eGFR results < 60 ml/min/1.73m2 is predicted if the 2009 CKD-EPI equation, calculated without the race modifier, is replaced with the 2021 CKD-EPI equation.