CKD-EPI Equations for Glomerular Filtration Rate (GFR)
Estimates GFR in CKD patients using serum creatinine, cystatin C, or both.
The 2021 CKD-EPI equation is now the recommended standard, and 2021 CKD-EPI creatinine is currently recommended by the ASN and NKF for GFR reporting in the United States. This version does not include race. See here for our full statement.
The 2021 equation, for the same creatinine value, will estimate a lower GFR for Black patients and a higher GFR for non-Black patients.
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Patients with decreased GFR are at higher risk of progressive kidney disease. Management of contributing risk factors, such as diabetes and hypertension, is critical to slowing progression. Investigation of the underlying cause of decreased GFR is warranted if not clear from the history.
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Medications should be dose-adjusted for the most recent available eGFR (in this setting, eGFR and creatinine clearance may be used interchangeably, though they are physiologically different terms). Cutoffs for many medications are <60, <45, and <30 mL/min/m2, as well as adjustments for advanced kidney disease and dialysis patients.
Patients should be classified into CKD stage by both eGFR and albuminuria status. Patients with decreased GFR, increased urinary albumin excretion or both, are at high risk of progressive CKD and should be referred to nephrology for further management.
