Advancing Equity in Kidney Care: National Perspectives on Implementing Race-Neutral eGFR Equations

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Background: Previous national guidelines recommended equations for estimating glomerular filtration rate (eGFR) which included a race-based modifier that falsely inflated values for Black patients. This practice contributed to the underdiagnosis of chronic kidney disease (CKD) and delays in specialty referral and transplantation. In 2021, new consensus guidelines introduced race-neutral eGFR calculation. This abstract presents initial findings from phase one of a broader study exploring implementation of race-neutral eGFR across stakeholder groups: research and policy leaders, healthcare providers, and patients. Here, we focus on national research and policy leaders’ perspectives. Methods: We are conducting semi-structured interviews with national research and policy leaders (N=16). Informed by Public Health Critical Race Praxis, interviews explore participants’ roles in CKD policy, the rationale and goals of race-neutral reforms, the policy development process, barriers encountered, strategies to address them, and reflections on impact and future directions. Transcripts are being analyzed thematically to identify themes and policy insights. Results: Preliminary analyses identified key challenges and facilitators to implementing race-neutral eGFR, including communication barriers, system-wide demands, and cost implications. Preliminary themes include: 1) Communicating change– participants described challenges in explaining the shift to patients unaware of race-based modifiers and resistance from healthcare workers; 2) System-wide, multidisciplinary implementation– successful adoption requires coordination across policy, clinical care, and specialties to support newly diagnosed patients; (3) Cost and consequence- delayed diagnoses leading to costly comorbidities that complicate transplant eligibility. Many emphasize that getting patients on the transplant list is only a first step, addressing comorbidities and structural barriers is essential to ensure long-term access and equity. Conclusion: Race-neutral eGFR implementation is a complex but necessary step toward health equity in nephrology. Sustained, equity-driven structural changes embedded within the health policy landscape are needed to support patients throughout the full continuum of CKD and end-stage renal disease care. Funding: Private Foundation Support

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