Clinical Update
Estimated Glomerular Filtration Rate (eGFR) Updates
The National Kidney Foundation and American Society of Nephrology joint task force recently released recommendations on including a race variable in eGFR reporting (PMID: 34563581).
Based on these recommendations and internal review, the following changes will occur on February 26, 2022:
Adult eGFR Creatinine Calculation
The adult eGFR creatinine equation will be updated from MDRD to the 2021 CKD-EPI creatinine equation in all blood-based creatinine panels (e.g. BMP).
This equation utilizes creatinine, sex, and age, but does not include a race variable.
The new upper reporting limit will increase from 60 to 150 mL/min/1.73m2.
Adult Cystatin C-Based eGFR
eGFR confirmation with a cystatin C-based calculation is recommended near clinical decision-making thresholds.
Two new equations will be available:
2012 eGFR cystatin C (CYSTC)
- Variables include cystatin C, age, and sex, but not race.
2021 eGFR creatinine-cystatin C (CRECYS)
- Variables include creatinine, cystatin C, age, and sex, but not race.
Pediatric eGFR Reporting
The task force recommendations focus on the adult population; however, several changes related to EHR transformation will affect the pediatric population:
– The Bedside Schwartz creatinine factor will no longer be reported. The Bedside Schwartz creatinine equation will be provided as a comment: Bedside Schwartz equation = 0.413 x [height (cm) / serum creatinine (mg/dL)].
– The 2012 Schwartz cystatin C equation will be utilized for patients 2-17 years old when cystatin C (CYSTC) is ordered.
– The 2021 eGFR creatinine-cystatin C equation (CRECYS) is valid for adults only and will not be available to order for patients less than 18 years of age.