The eGFR Race Adjustment and Why It Was Dropped

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The eGFR Race Adjustment and Why It Was Dropped

By Your Health Magazine Health Information Team

You open an older blood-test report and see two kidney function results: one labeled for African American patients and another labeled “non-African American.” On a newer report, there may be only one number. Did your kidney function change, or did the calculation change?

In many cases, the answer is the calculation. For years, commonly used estimated glomerular filtration rate equations included a race adjustment that produced a higher eGFR for patients identified as Black. Kidney organizations recommended replacing that approach in 2021 with a new equation that does not use race.

What Does “eGFR Non-African American” Mean?

If your patient portal displays wording such as “egfr non african american s,” you are likely viewing a result calculated with an older laboratory method. The wording varies among laboratories, so any additional letter or suffix should be clarified with the laboratory or ordering clinician.

Under the older system, a laboratory could report one eGFR value for a person classified as non-Black and a different, higher value for someone classified as Black, even when their age, sex, and creatinine level were otherwise identical. The “non-African American” label did not indicate a separate blood test. It identified which version of the mathematical calculation had been applied.

Many laboratories now report a single race-free result. An old label may still appear in archived records, downloaded health data, or systems that have not updated how historical results are displayed.

What eGFR Actually Measures

Glomerular filtration rate describes how much blood the kidneys filter over time. Measuring it directly requires specialized procedures, so routine blood panels usually report an estimate called eGFR.

The estimate is commonly calculated from serum creatinine, a waste product associated with normal muscle activity. Healthy kidneys remove creatinine from the blood. When filtration declines, creatinine often rises, although the relationship is not exact.

Current adult creatinine-based equations generally consider:

• Serum creatinine
• Age
• Sex

Race is no longer included in the recommended 2021 CKD-EPI creatinine equation. Readers who want more background on the calculation can review this guide to calculating GFR and understanding kidney function.

Why Was Race Added in the First Place?

Earlier equations were developed by comparing measured kidney filtration with characteristics observed in study populations. Researchers found statistical differences in average creatinine levels between participants who identified as Black and those who did not. A multiplier was therefore added to raise the calculated eGFR for Black patients.

However, race is a broad social classification, not a precise measurement of muscle mass, genetics, diet, health, environmental exposure, or kidney function. People within any racial group vary considerably. Applying one adjustment to every Black patient could not accurately represent that individual variation.

The adjustment also created practical concerns. Because it generated a higher eGFR for Black patients, it could move someone above a decision threshold used for chronic kidney disease staging, nephrology referral, medication decisions, or kidney transplant evaluation. That raised concerns that the equation could contribute to delayed recognition or treatment of kidney disease.

Why the Adjustment Was Dropped

In 2021, a joint task force of the National Kidney Foundation and the American Society of Nephrology recommended immediate use of the new CKD-EPI creatinine equation without a race coefficient. The equation was developed using a diverse population and was designed to provide acceptable performance without requiring clinicians or laboratories to assign a racial category.

The change was intended to establish one consistent approach for adults and reduce the risk that race-based calculations would reinforce inequities in kidney care. It does not mean that ancestry, lived experience, or disparities in kidney disease are unimportant. Rather, it means race is not considered an appropriate stand-in for a person’s individual biology within this calculation.

Will the New Equation Change Your Number?

It may. Compared with the older 2009 CKD-EPI creatinine equation, the 2021 race-free equation generally produces a somewhat lower result for people whose old eGFR included the Black race multiplier. For people previously classified as non-Black, the new result may be somewhat higher.

A difference between an old and new report does not automatically mean the kidneys improved or worsened. The reports may have used different equations. Look for language identifying the calculation, and ask your clinician or laboratory which equation was used before comparing results over time.

Even when the same equation is used, eGFR can fluctuate. Creatinine may be influenced by muscle mass, recent meat intake, intense exercise, illness, hydration status, certain medications, and rapidly changing kidney function. Clinicians therefore interpret trends and surrounding circumstances rather than relying on one isolated result.

How to Interpret an eGFR Result

For many adults, an eGFR of 60 or higher is not considered evidence of chronic kidney disease by itself. An eGFR between 60 and 89 can still be significant when other signs of kidney damage are present, such as elevated urine albumin or structural abnormalities.

An eGFR below 60 may indicate kidney disease, but chronic kidney disease generally requires reduced filtration or another marker of kidney damage to persist for more than three months. A single low result can occur during dehydration, infection, medication effects, or an acute kidney problem and often needs follow-up.

An eGFR of 15 or lower indicates severely reduced kidney function and requires prompt medical evaluation. The number alone does not determine whether someone needs dialysis; symptoms, laboratory findings, the rate of change, and the overall clinical picture also matter.

Other Tests Provide Important Context

eGFR is an estimate, not a complete diagnosis. A urine albumin-to-creatinine ratio can identify albumin leaking into the urine, which may be an early sign of kidney damage even when eGFR remains above 60.

When creatinine may be misleading or the result is close to an important treatment threshold, a clinician may order cystatin C. This blood marker is less dependent on muscle mass. Combining creatinine and cystatin C can improve the accuracy of the estimate in appropriate situations.

Blood pressure, diabetes status, medication use, urinalysis findings, and changes over time also help determine what an eGFR result means. General information about kidney conditions and testing is available through MedlinePlus kidney disease resources.

Questions to Ask About an Older Lab Report

• Which eGFR equation was used for this result?
• Was the number calculated with a race adjustment?
• Can it be compared directly with my newer results?
• Should the test be repeated when my health and hydration are stable?
• Have I had a urine albumin-to-creatinine ratio?
• Would cystatin C provide useful confirmation?

When to Seek Care

Contact a primary care physician or other qualified healthcare professional if your eGFR is below 60, has fallen significantly from prior results, or is accompanied by blood or excess protein in the urine. Evaluation is also important for people with diabetes, high blood pressure, heart disease, or a family history of kidney failure, even when they feel well. A nephrologist may help when kidney function is persistently reduced, declining rapidly, or difficult to interpret.

Seek prompt medical attention for a major decrease in urination, severe or rapidly worsening swelling, shortness of breath, persistent vomiting, confusion, or chest pain. These symptoms can have several causes, but they may signal a serious problem requiring timely assessment.

The main takeaway is reassuring: seeing “non-African American” on an old report does not describe a separate kidney condition. It reflects an older calculation method. Today’s race-free approach provides one equation for everyone, while clinicians use additional tests and the pattern over time to understand each person’s kidney health.