Impact of Adopting the Race/Ethnicity-Free 2021 CKD-EPI Equation on Cardiovascular Risk Stratification in a Multiethnic European Population: Results from the HELIUS Study
References
- Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet. 2017;389(10075):1238–1252. DOI: 10.1016/S0140-6736(16)32064-5
- European Society of Cardiology. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42:3227–3274. DOI: 10.1093/eurheartj/ehab637
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. Evaluation and management of chronic kidney disease: synopsis of the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline. Ann Intern Med. 2013;158(11):825–830. DOI: 10.7326/0003-4819-158-11-201306040-00007
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4s):S117–S314. DOI: 10.1016/j.kint.2023.10.018
- Bello AK, Okpechi IG, Levin A, Ye F, Damster S, Arruebo S, et al. An update on the global disparities in kidney disease burden and care across world countries and regions. Lancet Glob Health. 2024;12(3):e382–e395. DOI: 10.1016/S2214-109X(23)00570-3
- Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF
3rd , Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–612. DOI: 10.7326/0003-4819-150-9-200905050-00006 - Emrich IE, Pickering JW, Götzinger F, Kramann R, Kunz M, Lauder L, et al. Comparison of three creatinine-based equations to predict adverse outcome in a cardiovascular high-risk cohort: an investigation using the SPRINT research materials. Clin Kidney J. 2024;17(2):
sfae011 . DOI: 10.1093/ckj/sfae011 - Duggal V, Thomas IC, Montez-Rath ME, Chertow GM, Kurella Tamura M. National estimates of CKD prevalence and potential impact of estimating glomerular filtration rate without race. J Am Soc Nephrol. 2021;32(6):1454–1463. DOI: 10.1681/ASN.2020121780
- Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, et al. New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med. 2021;385(19):1737–1749. DOI: 10.1056/NEJMoa2102953
- Fu EL, Coresh J, Grams ME, Clase CM, Elinder CG, Paik J, et al. Removing race from the CKD-EPI equation and its impact on prognosis in a predominantly White European population. Nephrol Dial Transplant. 2023;38(1):119–128. DOI: 10.1093/ndt/gfac197
- An D-W, Mokwatsi GG, Zhang D-Y, Martens DS, Yu Y-L, Chori BS, et al. Evaluation of race-free eGFR equations in individuals of different ethnicity. Blood Press. 2025;34(1):
2533456 . DOI: 10.1080/08037051.2025.2533456 - Matsushita K, Kaptoge S, Hageman S, Sang Y, Ballew SH, Grams ME, et al. Including measures of chronic kidney disease to improve cardiovascular risk prediction by SCORE2 and SCORE2-OP. Eur J Prev Cardiol. 2023;30(1):8–16. DOI: 10.1093/eurjpc/zwac176
- Snijder MB, Galenkamp H, Prins M, Derks EM, Peters RJG, Zwinderman AH, et al. Cohort profile: the Healthy Life in an Urban Setting (HELIUS) study in Amsterdam, The Netherlands. BMJ Open. 2017;7(12):
e017873 . DOI: 10.1136/bmjopen-2017-017873 - Stronks K, Snijder MB, Peters RJG, Prins M, Schene AH, Zwinderman AH, et al. Unravelling the impact of ethnicity on health in Europe: the HELIUS study. BMC Public Health. 2013;13:402. DOI: 10.1186/1471-2458-13-402
- Mandrekar JN. Simple statistical measures for diagnostic accuracy assessment. J Thorac Oncol. 2010;5(6):763–764. DOI: 10.1097/JTO.0b013e3181dab122
- Caetano SJ, Sonpavde G, Pond GR. C-statistic: A brief explanation of its construction, interpretation and limitations. Eur J Cancer. 2018:90:130–132. DOI: 10.1016/j.ejca.2017.10.027
- Hsu CY, Yang W, Parikh RV, Anderson AH, Chen TK, Cohen DL, et al. Race, genetic ancestry, and estimating kidney function in CKD. N Engl J Med. 2021;385(19):1750–1760. DOI: 10.1056/NEJMoa2103753
- Delgado C, Baweja M, Crews CC, Eneanya ND, Gadegbeku CA, Inker LA, et al. A unifying approach for GFR estimation: Recommendations of the NKF-ASN Task Force on reassessing the inclusion of race in diagnosing kidney disease. Am J Kidney Dis. 2022;79(2):268–288.e1. DOI: 10.1053/j.ajkd.2021.08.003
- Levey AS, Titan SM, Powe NR, Coresh J, Inker LA. Kidney disease, race, and GFR estimation. Clin J Am Soc Nephrol. 2020;15(8):1203–1212. DOI: 10.2215/CJN.12791019
- Gaillard F, Ould Rabah M, Aubert O, Garcelon N, Neuraz A, Legendre C, et al. Impact of muscle mass on the performance of creatinine-based eGFR equations and mortality risk assessment after kidney transplantation. J Cachexia Sarcopenia Muscle. 2025;16(5):
e70032 . DOI: 10.1002/jcsm.70032 - Huisman B, Agyemang C, van den Born, Peters RJG, Vogt L, Snijder MB, et al. Discrepancies in estimated glomerular filtration rate and albuminuria levels in ethnic minority groups – The multiethnic HELIUS cohort study. EClinicalMedicine. 2022;45:
101324 . DOI: 10.1016/j.eclinm.2022.101324 - Wang Y, Levey AS, Inker LA, Jessani S, Bux R, Samad Z, et al. Performance and determinants of serum creatinine and cystatin C-based GFR estimating equations in South Asians. Kidney Int Rep. 2021;6(4):962–975. DOI: 10.1016/j.ekir.2021.01.005
- Astley ME, Chesnaye NC, Gambaro G, Ortiz A, Hallan S, Carrero JJ, et al. Prevalence of reduced eGFR in European adults using KDIGO and age-adapted eGFR thresholds. Nephrol Dial Transplant. 2025;40(12):2326–2337. DOI: 10.1093/ndt/gfaf112
DOI: https://doi.org/10.5334/gh.1579 | Journal eISSN: 2211-8179
Language: English
Page range: 62 - 62
Submitted on: Feb 3, 2026
Accepted on: Aug 3, 2026
Published on: Aug 21, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Keywords:
© 2026 Brechje J. M. V. Huisman, Taryn G. Vosters, Charles Agyemang, Bert-Jan H. van den Born, Irene G. M. van Valkengoed, Liffert Vogt, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.