The following is a summary of “Reclassification of CKD in living kidney donors with the refitted race-free eGFR formula,” published in the FEBRUARY 2023 issue of Surgery by Orandi, et al.

The 2021 formula for estimating glomerular filtration rate (eGFR) developed by the Chronic Kidney Disease (CKD) Epidemiology Collaboration removed the Black race from the 2009 equation. This may have unintended consequences, such as reclassifying Black living kidney donors as having more advanced CKD, which can exacerbate racial disparities in living donation.

National data were used to quantify the stage of CKD reclassification based on eGFR for Black living donors before and after donation.

About 17.7% of the 6,365 Black living donors were categorized under the 2021 methodology as having a higher CKD stage before donation. In addition, 25.5% of the 4,149 Black living donors with at least two post-donation creatinine readings were categorized using the 2021 algorithm as having a higher stage of CKD.

The removal of race in the formula may lead to incorrectly labeling potential Black donors with CKD. Therefore, there was a need for a validated eGFR formula for donors, the use of measured and not eGFR, and educating non-transplant providers regarding the interpretation of CKD staging in living donation.