Performance of the race-free CKD-EPI creatinine-based eGFR equation in a Danish cohort with measured GFR

Abstract Background In 2021, an updated Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimated glomerular filtration rate (eGFR) without a coefficient for race (CKD-EPI21) was developed. The performance of this new equation has yet to be examined among specific patient groups. Methods We compared the performances of the new CKD-EPI21 equation and the 2009 equation assuming non-Black race (CKD-EPI09-NB) in patients with GFR measured by chromium-51-EDTA plasma clearance at Aarhus University Hospital in Denmark during 2010–2018. We examined bias, accuracy, precision, and correct classification of chronic kidney disease (CKD) stage using chromium-51-EDTA clearance as the reference standard. We assessed the performance in the total cohort, cancer patients, and potential living kidney donors. We also assessed the performance stratified by CKD stage in the total cohort. Results In this predominantly White population, the CKD-EPI21 equation performed slightly better than the CKD-EPI09-NB equation in both the total cohort (N = 4 668) and in cancer patients (N = 3 313) and potential living kidney donors (N = 239). In the total cohort, the CKD-EPI21 equation demonstrated a slightly lower median absolute bias (−0.2 versus −4.4 ml/min/1.73 m2), and a similar accuracy, precision, and correct classification of CKD stage compared with the CKD-EPI09-NB equation. When stratified by CKD stage, the CKD-EPI09-NB equation performed slightly better than the CKD-EPI21 equation among patients with a measured GFR <60 ml/min/1.73 m2. Conclusions In a selected cohort of Danish patients with measured GFR, the CKD-EPI21 equation performed slightly better than the CKD-EPI09-NB equation except for patients with a measured GFR <60 ml/min/1.73 m2 where CKD-EPI09-NB performed slightly better although the differences were considered clinically insignificant.