Implementation of the 2021 CKD-EPI Equation

Rationale for Prospective Implementation

• The National Kidney Foundation recommends immediately replacing older eGFR equations with the new CKD-EPI 2021 equation for all current and future calculations, as clinical decision-making was based on the equation available at the time of measurement, and those decisions were appropriate given the standards of that era 1, 3

Mandatory Prospective Implementation

• The Kidney Disease Outcomes Quality Initiative (KDOQI) Work Group supports the use of the race-free 2021 CKD-EPI eGFRcr, 2021 CKD-EPI eGFRcr-cys, and the 2012 CKD-EPI eGFRcys equations for adults, which do not include race as a variable in computing or reporting of eGFR and align with the NKF-ASN Task Force recommendations on use of race in diagnosis of kidney disease 1, 2, 4
• Use of race in the computation of eGFR should be avoided, and the same equation should be used within geographical regions (as defined locally) and as large as possible 1, 2, 4

Special Considerations

• When eGFR is thought to be inaccurate (extremes of muscle mass, body composition, or critical clinical decisions), consider using the combined creatinine-cystatin C equation (eGFRcr-cys) or measured GFR with exogenous markers, as recommended by the American Journal of Kidney Diseases 1, 5