Key result
Race-free 2021 CKD-EPI yields lower eGFR and ~12% lower accuracy vs 2009 CKD-EPI in Black patients.
Why the study?
Studies comparing 2009 and 2021 CKD-EPI equations against measured GFR showed worsening CKD classification in Black populations, prompting a review to understand the extent of eGFR differences between equations with and without the race modifier.
Does the 2021 CKD-EPI equation without race modifier alter eGFR calculation and accuracy compared to the 2009 CKD-EPI equation with race adjustment in Black populations?
Systematic Review
Does the 2021 CKD-EPI equation without race modifier alter eGFR calculation and accuracy compared to the 2009 CKD-EPI equation with race adjustment in Black populations?
Absolute Event Rate: 80.357% vs 89.757%
The 2021 CKD-EPI equation omitting the race correction factor leads to lower calculated eGFR and decreased accuracy compared to the 2009 race-inclusive equation in Black populations.
May misclassify CKD severity in Black adults; leaves open the optimal equation pending direct GFR validation studies.
The National Kidney Foundation-American Society of Nephrology Task Force has recommended the 2021 CKD-EPI equation that omits the race correction factor following conversations concerning the social construction of race. Studies comparing the estimated GFR based on the 2009 and 2021 CKD-EPI equations against measured GFR have demonstrated a worsening of CKD classification in Black populations when using the 2021 equation. The objective of this review is to understand the extent of the difference in eGFR calculated by CKD-EPI equations with and without the Black race modifying coefficient by examining this outcome in literature studies. Embase, PubMed, and Web of Science databases were surveyed in August 2024 for literature published from 2021 onwards directly comparing the 2009 and 2021 CKD-EPI formulae in Black populations. 20 full text articles meeting the pre-established criteria are included in the review and are analyzed by outcomes in mean eGFR, CKD reclassification, percent accuracy, and drug eligibility. Statistical analysis is conducted with R 4.2.3 software. Mean eGFR in Black populations of the selected studies is 89.757 (18.65, SD) using the 2009 race inclusive equation compared to 80.357 (17.32) using the 2021 equation. The 2009 CKD-EPI equation demonstrates 11-12.5% greater P15 accuracy than the 2021 equation in two cohorts. Creatinine based eGFR equations omitting the correction factor in Black populations therefore lead to inaccurate renal function indices when compared to the gold standard measured GFR.
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Chelsea C. Grant (2026) conducted a systematic review in Chronic Kidney Disease. 2021 CKD-EPI equation without race modifier vs. 2009 CKD-EPI equation with race adjustment was evaluated on Mean eGFR. The 2021 CKD-EPI equation without the race modifier yielded a lower mean eGFR (80.357 vs 89.757) and 11-12.5% lower P15 accuracy compared to the 2009 race-inclusive equation in Black populations.
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