Implications of Implementing the 2021 CKD-EPI Equation Without Race on Managing Patients With Kidney Disease in British Columbia, Canada

Abstract

IntroductionWe investigated the implications of implementing race-free CKD-EPI 2021 equation among real-world CKD patients from British Columbia, Canada. MethodsThis study included non-dialysis dependent CKD patients aged ≥19 years who were registered in Patient Records and Outcome Management Information System (PROMIS) as of March 31, 2016 (index date) with ≥1 serum creatinine measurement within 1 year prior to index date. Patients with history of kidney transplantation before index date were excluded. CKD-EPI 2021 versus 2009 equation was the exposure variable. Difference in mean eGFR and number(%) of patients reclassified to a different eGFR category were estimated. Used Fine and Gray sub-distribution hazard model to investigate the association between change in eGFR category and progression to kidney failure (incident maintenance dialysis or kidney transplantation) within 2 years. ResultsIncluded 11,604 patients (median age 73 years, 52% male). Compared to 2009 equation, eGFR from 2021 equation was on average 2.7 ml/min/1.73m2 higher. Variation was higher among males. Overall, ∼17% of the study sample were reclassified to a category with higher eGFR by 2021 equation (switchers). Highest proportion (28%) of patients were reclassified from G5 to G4. Risk of progressing to kidney failure was 22% less among switchers compared to non-switchers [adjusted sub-distribution HR (95% CI): 0.78 (0.65, 0.94)]. ConclusionCKD-EPI 2021 equation appeared to provide higher eGFR compared to 2009 equation. This higher eGFR values appeared to be concordant with subsequent real-world CKD progression outcomes. Higher eGFR from 2021 equation may have substantial clinical implications in both diagnosis as well as long-term care of CKD patients.