Changing clinical algorithms to remove race adjustment has been proposed and implemented for multiple health conditions. Removing race adjustment from estimated glomerular filtration rate (eGFR) equations may reduce disparities in chronic kidney disease (CKD), but has not been studied in clinical practice after implementation. Here, we assessed whether implementing an eGFR equation (CKD-EPI 2021) without adjustment for Black or African American race modified quarterly rates of nephrology referrals and visits within a single healthcare system, Stanford Health Care (SHC). Our cohort study analyzed 547,194 adult patients aged 21 and older who had at least one recorded serum creatinine or serum cystatin C between January 1, 2019 and September 1, 2023. During the study period, implementation of CKD-EPI 2021 did not modify rates of quarterly nephrology referrals in those documented as Black or African American or in the overall cohort. After adjusting for capacity at SHC nephrology clinics, estimated rates of nephrology referrals and visits with CKD-EPI 2021 were 34 (95% CI 29, 39) and 188 (175, 201) per 10,000 patients documented as Black or African American. If race adjustment had not been removed, estimated rates were nearly identical: 38 (95% CI: 28, 53) and 189 (165, 218) per 10,000 patients. Changes to the eGFR equation are likely insufficient to achieve health equity in CKD care decision-making as many other structural inequities remain.

翻译：临床算法的调整以移除种族调整已被提出并应用于多种健康状况。从估算肾小球滤过率（eGFR）方程中移除种族调整可能减少慢性肾脏病（CKD）中的差异，但实施后在临床实践中尚未得到研究。在此，我们评估了在单一医疗体系——斯坦福医疗中心（SHC）内，实施无黑人或非裔美国人种族调整的eGFR方程（CKD-EPI 2021）是否改变了肾病转诊和就诊的季度率。我们的队列研究分析了2019年1月1日至2023年9月1日期间至少有一次血清肌酐或血清胱抑素C记录的547,194名21岁及以上成年患者。研究期间，CKD-EPI 2021的实施并未改变被记录为黑人或非裔美国人患者或整个队列的季度肾病转诊率。在调整SHC肾病门诊容量后，使用CKD-EPI 2021的肾病转诊和就诊估算率分别为每10,000名被记录为黑人或非裔美国人患者中34次（95% CI 29, 39）和188次（175, 201）。若未移除种族调整，估算率几乎相同：每10,000名患者中38次（95% CI: 28, 53）和189次（165, 218）。由于许多其他结构性不平等依然存在，仅修改eGFR方程可能不足以在CKD护理决策中实现健康公平。