Background The National Kidney Foundation recently endorsed the refit Chronic Kidney Disease Collaboration (CKD-EPI) equation for estimated glomerular filtration rate (eGFR) using creatinine, age and sex [2021 eGFRCr(AS)] without a coefficient for race. We evaluated the impact of adopting the 2021 eGFRCr(AS) equation or a variation of the 2009 CKD-EPI eGFR equation without race [2009 CKD-EPI eGFRCr(ASR-NB)] compared to the original CKD-EPI eGFR [2009 eGFRCr(ASR)]. Methods The studied population included patients with a clinically ordered iothalamate clearance (n = 33 889). Bias was assessed as the difference between measured and estimated GFR, P30 was defined as the percentage of estimates within 30% of measured GFR, and concordance was determined according to relevant clinical thresholds. Results Among Black patients, the median bias for 2009 eGFRCr(ASR), 2009 eGFRCr(ASR-NB), and 2021 eGFRCr(AS) was −1.32 mL min−1 (1.73 m2)−1 (95CI −2.46 to −0.26), −8.81 mL min−1 (1.73 m2)−1 (95CI −9.93 to −7.58), and −6.08 mL min−1 (1.73 m2)−1 (95CI −7.18 to −4.92), respectively. The median bias among non-Black patients was −0.15 m min−1 (1.73 m2)−1 (95CI −0.84 to −0.08) for 2021 eGFRcr(AS) compared to −3.09 mL min−1 (1.73 m2)−1 (95CI −3.17 to −3.03) for the 2009 eGFRCr(ASR). P30 and concordance were not significantly different in either racial group. The net reclassification improvement at a measured GFR <20 mL min−1 (1.73 m2)−1 was 6.4% (95CI 0.36 to 12.4) for Black patients and −5.1% (95CI −6.0 to −4.1) for non-Black patients using the 2021 eGFRCr(AS) equation. Conclusions Overall, the change in reported eGFR was minimal. However, these changes led to significant reclassification improvements at lower eGFR, which will indirectly improve equitable access to CKD resources.

中文翻译：

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Refit CKD-EPI 2021 基于肌酐的 eGFR 方程的临床影响

背景国家肾脏基金会最近批准了使用肌酐、年龄和性别 [2021 eGFRCr(AS)] 估算肾小球滤过率 (eGFR) 的改装慢性肾脏病协作 (CKD-EPI) 方程，而没有种族系数。与原始 CKD-EPI eGFR [2009 eGFRCr( ASR)]。方法 研究人群包括临床上要求清除碘酞酸盐的患者 (n = 33 889)。偏差被评估为测量的和估计的 GFR 之间的差异，P30 被定义为在测量的 GFR 的 30% 内的估计百分比，并且根据相关的临床阈值确定一致性。结果在黑人患者中，2009 eGFRCr(ASR)、2009 eGFRCr(ASR-NB) 和 2021 eGFRCr(AS) 的中位偏差为 -1.32 mL min-1 (1.73 m2)-1 (95CI -2.46 to -0.26), -8.81 mL min -1 (1.73 m2)-1 (95CI -9.93 至 -7.58) 和 -6.08 mL min-1 (1.73 m2)-1 (95CI -7.18 至 -4.92)。与 2021 eGFRcr(AS) 相比，非黑人患者的中位偏差为 -0.15 m min-1 (1.73 m2)-1 (95CI -0.84 至 -0.08)，而 -3.09 mL min-1 (1.73 m2)-1 ( 2009 eGFRCr(ASR) 的 95CI -3.17 至 -3.03)。P30 和一致性在两个种族组中没有显着差异。在测量的 GFR <20 mL min-1 (1.73 m2)-1 时，黑人患者的净重新分类改善率为 6.4% (95CI 0.36 至 12.4)，非黑人患者为 -5.1% (95CI -6.0 至 -4.1)使用 2021 eGFRCr(AS) 方程。结论 总体而言，报告的 eGFR 变化很小。然而，