AACC/NKF guidance document on improving equity in chronic kidney disease care

June 30, 2023
The purpose of this guidance document is to provide a tool to facilitate the implementation of the NKF-ASN Task Force recommendations in clinical laboratories.

Despite significant progress in disease diagnosis and treatment, racial and ethnic minorities experience lower quality of care and poorer outcomes for several health conditions compared to nonminorities. A joint task force was formed by the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) to reassess the inclusion of race in diagnosing kidney diseases (KDs), risk stratification, and classification.

The NKF-ASN Task Force detailed their recommendations and rationale in interim and final reports. The recommendations can be summarized as follows:

  1. All laboratories should immediately implement the CKD-EPI 2021 (Chronic Kidney Disease Epidemiology Collaboration) creatinine-based eGFR (eGFRcr) equation that was developed without the use of the race coefficient for US adults.
  2. National efforts should be undertaken to facilitate increased, routine, and timely use of cystatin C, in populations at risk for chronic kidney disease (CKD) or who have CKD. The race-neutral CKD-EPI 2012 eGFRcys and CKD-EPI 2021 eGFRcr-cys equations should be adopted to provide more accurate first-line or confirmatory testing, as appropriate for the clinical setting.
  3. Research on GFR estimation with new endogenous filtration markers and on interventions to eliminate racial and ethnic disparities in KD should be encouraged and funded.

AACC release

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