National Kidney Foundation and U.S. Pharmacy Organizations Call for Transition to Race-Agnostic eGFR in Medication Decision-Making

NEW YORK, June 8, 2026 /PRNewswire/ -- A coalition of leading U.S. pharmacy organizations, in collaboration with the National Kidney Foundation (NKF), is urging a nationwide transition to race-free estimated glomerular filtration rate (eGFR), adjusted for body surface area, for medication-related decision-making—marking a significant step forward in modernizing kidney care. The new national guidance is based on a recently endorsed multi-organization consensus statement supporting the transition. The guidance emphasizes accuracy, and patient safety in kidney function assessment

The recommendation calls for replacing the long-standing Cockcroft-Gault estimated creatinine clearance (eCrCL) equation with newer, race-free eGFR equations, using the 2021 CKD-EPI formula. The shift reflects growing clinical evidence, evolving regulatory guidance, and a broad expert consensus that eGFR provides a more accurate, consistent, and equitable assessment of kidney function.

"This transition represents a critical advancement in how we estimate kidney function," said Joseph Vassalotti, MD, Chief Medical Officer at NKF. "By adopting race-free eGFR equations, we avoid oversimplifications and biases inherent in categorizing all people by two racial categories, thus improving drug prescription practice, while also advancing equity in patient care."

Why This Change Matters Now

For nearly five decades, the Cockcroft-Gault equation has been widely used to guide medication dosing in patients with impaired kidney function. However, changes in clinical practice, laboratory standardization, and population diversity have exposed important limitations. Modern eGFR equations offer several advantages, including greater accuracy with validation against measured GFR, which is the current clinical standard.

Using race-agnostic eGFR also supports more equitable care, alignment with current FDA recommendations for pharmaceutical studies, improved performance with standardized serum creatinine tests, and increased consistency across clinicians and clinical practices.

"Healthcare has evolved, and our tools must evolve with it," said Andrew Bzowyckyj, PharmD, BCPS, CDCES, Senior Scientific Director, Learning Consultant at NKF. "Continuing to rely on outdated equations risks both patient safety and consistency in care delivery."

A More Accurate and Equitable Approach

The coalition's consensus statement supports adoption of the 2021 CKD-EPI race-agnostic eGFR equation, with appropriate adjustment for body surface area when used for medication dosing. This approach more accurately predicts drug clearance, aligns kidney assessment across medical decisions, and reduces variability in clinical interpretation. "Every patient deserves care informed by the best available science," said Maurine Knighton, chief program officer at the Doris Duke Foundation. "We are proud to support the National Kidney Foundation and its partners in advancing this important consensus, which moves the field toward more accurate, consistent and equitable medication-related decision-making for people affected by kidney disease."

Addressing Limitations of Cockcroft-Gault

Developed using a small sample of 249 white male participants, the Cockcroft-Gault equation includes assumptions and adjustments that have not been broadly validated. Additional concerns include limited diversity during equation development, inconsistent use of body weight variables, and reduced accuracy due to changes in laboratory procedures and methods.

"These limitations are no longer theoretical, they have real implications for how medications are prescribed and managed," added National VP, Clinical Innovation and Population Health at NKF, Elizabeth Montgomery. "We now have better tools available, and it's time to use them."

A National Call to Action

The NKF workgroup emphasizes that successful implementation will require coordinated action across the healthcare ecosystem—including clinicians, health systems, laboratories, regulators, and educators. While widespread adoption will take time, use of race-agnostic eGFR is already increasing across research, regulatory frameworks, and clinical practice. Leaders in pharmacy and kidney care view this transition as a foundational step toward more precise and equitable treatment. "Change at this scale does not happen overnight," added Montgomery. "Momentum is building, and alignment across partners will be key to ensuring a smooth and effective transition."

About the Initiative

This effort is supported by major U.S. pharmacy organizations, including the American Association of Colleges of Pharmacy (AACP), American College of Clinical Pharmacy (ACCP), American Pharmacists Association (APhA), American Society of Health-System Pharmacists (ASHP), and Hematology/Oncology Pharmacy Association (HOPA), in partnership with the National Kidney Foundation. This initiative was supported by a grant from the Doris Duke Foundation.

About Kidney Disease

In the United States, CKD remains an under-recognized public health burden that impacts 1 in 7 adults, and 90 percent of those affected are unaware of their condition. Approximately 1 in 3 U.S. adults are at risk for CKD, but less than 20% are assessed with guideline-recommended testing, eGFR and uACR. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity, and family history. People of Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander descent are at increased risk for developing the disease. Black or African American people are about four times as likely as White people to develop kidney failure. Hispanic and Native American people experience kidney failure at approximately double the rate of White people.

About the National Kidney Foundation

The National Kidney Foundation is revolutionizing the fight to save lives by eliminating preventable kidney disease, accelerating innovation for the dignity of the patient experience, and dismantling structural inequities in kidney care, dialysis, and transplantation. For more information about NKF, visit www.kidney.org.

SOURCE National Kidney Foundation