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：通过更改临床算法以移除种族校正的方案已被提出并应用于多种健康状态。从估算肾小球滤过率（eGFR）公式中移除种族校正可能减少慢性肾脏病（CKD）中的健康差异，但实施后的临床实践尚未得到系统研究。本研究评估了在单一医疗系统斯坦福医疗中心（SHC）中，采用无黑人/非裔美国人种族校正的eGFR公式（CKD-EPI 2021）是否改变了肾内科转诊与就诊的季度发生率。我们开展的队列研究分析了547,194名年龄≥21岁的成年患者，这些患者在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胱抑素C检测记录。研究期间，实施CKD-EPI 2021并未改变黑人/非裔美国人群体或整体队列的季度肾内科转诊率。经SHC肾内科门诊容量调整后，采用CKD-EPI 2021时，黑人/非裔美国人患者的估算肾内科转诊率和就诊率分别为每万名患者34例（95%CI：29,39）和188例（175,201）。若未移除种族校正，估算率几乎相同：分别为每万名患者38例（95%CI：28,53）和189例（165,218）。由于众多结构性不平等问题依然存在，仅通过修改eGFR公式可能不足以实现CKD诊疗决策中的健康公平。