Impact of the CKD-EPI 2021 equation on the classification of CKD in older Australian adults.

Abstract

Background: A recalibrated version of CKD-EPI2009, without a race coefficient, was released in 2021 (CKD-EPI2021). This updated equation, implemented in the US, can result in the reclassification of chronic kidney disease (CKD) stage in a significant proportion of individuals. The aim of this study was to investigate the clinical impact of transitioning from the 2009 CKD-EPI (CKD-EPI2009) to the 2021 CKD-EPI (CKD-EPI2021) estimated glomerular filtration rate (eGFR) equation in generally healthy older Australians. Method(s): This was a prospective cohort study using data from 16,244 Australian community-dwelling adults aged >=70 years, in the ASPirin in Reducing events in the Elderly (ASPREE) study cohort. Baseline characteristics and long-term health outcomes were compared in participants who were reclassified to a different chronic kidney disease (CKD) stage with CKD-EPI2021 versus those with unchanged classification. Result(s): With CKD-EPI2021, baseline eGFR increased by a median of 3.8 mL/min/ 1.73m2 (interquartile range [IQR] 3.3, 4.4) resulting in the reclassification of 3,106 (20%) participants to a less advanced CKD stage and the reduction in the prevalence of CKD from 17% to 12%. Over a median follow-up period of 6.5 years (IQR 5.4, 7.9), there was no difference in disability-free survival (HR: 0.94, 95%CI:0.84-1.05), mortality (HR: 0.90, 95%CI:0.78-1.03), major cardiac events (HR: 0.94, 95%CI:0.79-1.13), or hospitalisations for heart failure (HR: 1.00, 95%CI:0.67-1.49) in reclassified, versus nonreclassified, participants. Conclusion(s): Implementing CKD-EPI2021 would raise eGFR by a median of nearly 4 ml/min/1.73m2, substantially reducing the proportion of older Australian adults classified as having CKD with no difference in long-term health outcomes among reclassified people. Transitioning to using the CKD-EPI2021 may result in a significant reduction in nephrology referrals in generally healthy, older adults.