Race-based kidney-function correction

Where in the source: Guideline 4 — Estimation of GFR

Direct National Kidney Foundation guideline showing KDOQI as the recommending institution and the MDRD equation as its preferred adult estimation method.

Where in the source: Evolution of Kidney Function Estimating Equations; Race in Estimated GFR Assessment in the United States

Traces MDRD, CKD-EPI, clinical guidelines and near-universal U.S. laboratory eGFR reporting as the linked research, professional and technical carriers of the race-inclusive calculation.

Where in the source: Rationale — Creatinine Metabolism; Prediction Equations Based on Serum Creatinine

Records the contemporary rationale that mean creatinine generation varied by race and its acknowledgement that creatinine equations were estimates with limited precision and exceptions requiring clearance measurement.

Where in the source: Probing the Rationale for a Race Coefficient; Disparities in Health and Health Care

Calls the biological rationale for the race coefficient questionable, describes race as social rather than biological and cautions that broad kidney-care disparities predated the coefficients and had not been conclusively attributed to them.

Where in the source: Guideline 4 — Estimation of GFR

Recommends routine equation-based estimation and laboratory reporting, the standard-setting step that placed a race-inclusive research equation into ordinary clinical workflows.

Where in the source: Introduction; Recommendations for Implementation

Describes the laboratory information-system changes, reporting conventions and coordination required to replace the older MDRD and 2009 CKD-EPI equations, documenting how the equations were operationalized at scale.

Where in the source: Introduction; Probing the Rationale for a Race Coefficient

Identifies eGFR-dependent decisions including medication use and dosing, contrast procedures, nephrology referral and transplant referral while presenting competing concerns about harms from retaining or removing the coefficient.

Where in the source: Potential Consequences; Tables 3–5

Explains that most available estimates of threshold effects were simulations rather than observations of clinical practice after implementation and that consequences for care, medications and trial eligibility were complex.

Where in the source: Results — Description of Current and New Equations; Table 3; Discussion

Shows that refitting changes estimates for Black and non-Black groups, reports remaining individual-level error and finds the combined creatinine-cystatin C equation more accurate than the creatinine-only alternatives.

Where in the source: Recommendations 1–3 and Implementation

Documents the 2021 professional reversal: immediate use of the refitted equation without race and a national effort to increase access to cystatin C for confirmation.

Where in the source: Recommendations for Implementing the CKD-EPI 2021 Race-Free Equations

Converts the task-force recommendation into detailed guidance for clinical laboratories, including simultaneous equation replacement, equation identification and coordination with clinicians and information-system teams.

Where in the source: Chapter 1, Practice Point 1.2.4.2

Extends the correction beyond the U.S. task force through a current international practice point that says use of race in eGFR computation should be avoided.

Where in the source: March 2023 CAP questionnaire; Table 1

Provides the basis for rating correction partial: about two-thirds of U.S. respondent laboratories reported adoption, while the remainder reported non-adoption or uncertainty in this survey.

Where in the source: Background

OPTN states that race-inclusive calculations made kidney function appear better for some Black candidates and could delay listing or the date on which transplant waiting time began to accrue.

Where in the source: Background; Policy

Documents the 27 July 2022 race-neutral eGFR requirement and the policy effective 5 January 2023 requiring hospitals to review eligible Black candidates and request retrospective waiting-time modifications.

Where in the source: First-year implementation results, data through 4 January 2024

The number and size of completed modifications provide observed evidence that the earlier equation affected a concrete transplant threshold for qualifying registrations, without establishing the coefficient as the cause of every wider disparity.

Where in the source: First-year implementation results, data through 4 January 2024

Reports that all 230 active kidney programs attested to reviewing their lists and that 14,701 waiting-time modifications had been processed, while the remediation pathway remained available for later documentation.