Abstract
Removal of the race coefficient from creatinine-based estimated glomerular filtration rate (eGFR) equations changes reported
kidney function for a meaningful share of patients, but the practical size of that change at the point of clinical decision-making is
reported inconsistently across health systems. We reanalysed 14,208 paired estimates from a regional laboratory network,
comparing the previous race-adjusted CKD-EPI 2009 equation against the race-free CKD-EPI 2021 equation, and examined
reclassification across the CKD stage 3 threshold and the nephrology referral threshold specifically. Among patients previously
coded as Black or of African descent, 31.2% moved from an eGFR above 60 mL/min/1.73m2 to below it, and 18.4% crossed the
referral threshold of 30 mL/min/1.73m2 without any change in serum creatinine, kidney biopsy finding, or clinical status. We
describe the downstream effect on medication dosing flags, transplant eligibility screening, and referral volume, and set out what
a laboratory changing equations should communicate to referring clinicians before the change, not after.
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