(New York City, NY – November 20, 2024) – Today the National Kidney Foundation (NKF) published “Moving Forward from Cockcroft and Gault Creatinine Clearance to Race-Free Estimated Glomerular Filtration Rate to Improve Medication-Related Decision-Making in Adults Across Healthcare Settings: A Consensus of the National Kidney Foundation Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions,” in the American Journal of Health-System Pharmacy online ahead of print. The paper aligns with the NKF and American Society of Nephrology 2021 Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases recommendations to implement the CKD-EPI race-free eGFR equations for both medical and medication-related decision-making, and provides expert consensus on how the healthcare community can make this transition.
More than 35 million adults in the United States have chronic kidney disease (CKD) with communities of color being disproportionately affected. The Cockcroft-Gault formula is the equation most frequently utilized for estimating kidney function to dose medications for people with kidney disease. It was developed in 1973 using data from 249 white males and has not been validated for use in more diverse patient populations or with the standardized serum creatinine assays used today .
“Concerted efforts to accelerate the transition from the Cockcroft-Gault formula to the more representative race-free 2021 CKD-EPI eGFR equations will ensure more accurate and consistent medication-related decisions among the diverse American population with low kidney function,” said Wendy St. Peter, workgroup co-chair.
“This paper, written by an interdisciplinary workgroup, will promote an understanding among people living with kidney diseases and clinicians that kidney function assessed by eGFR should be used to optimize medication-related decision-making across the US, added Joseph Vassalotti, NKF Chief Medical Officer.
Several factors make it an ideal time to transition from the Cockcroft-Gault equation to use of the 2021 CKD-EPI race-free eGFR. Pharmacokinetic studies of new medications have increasingly employed eGFR to evaluate kidney function which has resulted in a steadily rising number of product label dosing recommendations based on eGFR rather than Cockcroft-Gault eCrCL. The US Food and Drug Administration (FDA) issued guidance in 2024 recommending use of eGFR over Cockcroft Gault eCrCL to evaluate the impact on pharmacokinetics in patients with impaired kidney function. There is also new evidence that demonstrates eGFR adjusted for an individual’s body surface area better predicts clearance for several medications compared to Cockcroft Gault eCrCL.
The NKF facilitated formation of the Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions. Workgroup members below represent the diverse areas needed to develop support for health systems, clinical laboratories, electronic health record systems, compendia and data vendors, and health care practitioners in the transition to the race-free eGFR equations for medication-related decision-making. This publication signifies the first step in a multistep initiative to raise awareness of this important issue and drive the necessary practice transformation. The NKF looks forward to collaborating with other organizations, clinicians, and patients, on furthering this important work.
The full article can be found here: https://academic.oup.com/ajhp/advance-article/doi/10.1093/ajhp/zxae317/7903007
| Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decision | ||
Wendy L. St. Peter, PharmD, FNKF, FASN, FCCP, (Co-chair) University of Minnesota, College of Pharmacy | Mary Ann Kliethermes, BSPharm, PharmD, FAPhA, FCIOM American Society of Health-System Pharmacists | |
Andrew S. Bzowyckyj, PharmD, BCPS, CDCES (Co-chair) National Kidney Foundation | Tuan Le, MD Southern California Permanente Medical Group/Kaiser Permanente | |
Tracy Anderson-Haag, PharmD, BCPS, BCTXP Hennepin Healthcare | Brianna Martin, PharmD, BCPS Wolters Kluwer Health, Clinical Effectiveness | |
Linda Awdishu, PharmD, MAS University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences | Greg Miller, PhD Virginia Commonwealth University | |
Michael Blackman, MD, MBA Chair, Patient Safety Committee, Electronic Health Record Association (EHRA) Chief Medical Officer, Greenway Health | Joshua J. Neumiller, PharmD, CDCES Washington State University College of Pharmacy and Pharmaceutical Sciences | |
Andrew Bland, MD University of Illinois College of Medicine at Peoria Medical Associates Clinic
| Ann M. Philbrick, PharmD, BCACP, FCCP University of Minnesota College of Pharmacy
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Ethan Chan, PharmD, MS First Databank | Glenda V. Roberts, BS Icahn School of Medicine at Mt. Sinai | |
Cynthia Delgado, MD San Francisco Veterans Affairs Healthcare System and UCSF | Venita Le Schandorf, DNP, ARNP, FNP-BC Multicare Health System
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Rachel Eyler, PharmD, BCPS Wolters Kluwer Health, Clinical Effectiveness | Andrew Webb, PharmD, BCCCP Massachusetts General Hospital | |
Joanna Hudson, PharmD, BCPS, FASN, FCCP, FNKF The University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN | Thomas D. Nolin, PharmD, PhD, FCCP, FCP, FASN University of Pittsburgh School of Pharmacy | |
Sandra Kane-Gill, PharmD, MSc University of Pittsburgh, School of Pharmacy | ||
About Kidney Disease
In the United States, more than 35 million adults are estimated to have kidney disease, also known as chronic kidney disease (CKD)-and approximately 90 percent don't know they have it. About 1 in 3 adults in the U.S. are at risk for kidney disease. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity, and family history. People of Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander descent are at increased risk for developing the disease. Black or African American people are about four times as likely as White people to have kidney failure. Hispanic people experience kidney failure at about double the rate of White people.
About the National Kidney Foundation
The National Kidney Foundation is revolutionizing the fight to save lives by eliminating preventable kidney disease, accelerating innovation for the dignity of the patient experience, and dismantling structural inequities in kidney care, dialysis, and transplantation. For more information about NKF, visit www.kidney.org.
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Contact:
Paul McGee 716.523.6874
Email: paul.mcgee@kidney.org