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.
Huisman B, Vosters T, et al. • Global heart • 2026
Adoption of the race-free 2021 CKD-EPI equation did not meaningfully alter chronic kidney disease detection or cardiovascular risk stratification compared with the 2009 equation in a large multiethnic European cohort.
Key Findings
Results
The 2021 CKD-EPI equation produced lower eGFR values in African Surinamese and Ghanaian participants and marginally higher values in other ethnic groups compared to the 2009 equation.
The study included 21,617 participants from the HELIUS study in Amsterdam representing six ethnic groups: Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan adults aged 18-70 years.
Lower eGFR values in African-descent groups reflect removal of the race coefficient that previously upward-adjusted eGFR estimates for Black individuals.
Marginally higher values were observed in non-African groups under the 2021 equation.
Results
The transition to the 2021 CKD-EPI equation led to a modest increase in CKD prevalence among participants of African ancestry but did not affect overall CKD classification.
CKD was defined as eGFR <60 mL/min/1.73 m² and/or urinary albumin-to-creatinine ratio ≥3 mg/mmol.
Agreement between the 2009 and 2021 equations for CKD classification was 'almost perfect,' with Cohen's κ = 0.94–0.99.
The modest increase in CKD prevalence was limited to those of African descent (African Surinamese and Ghanaian participants).
Results
Sensitivity, specificity, and C-statistics for CKD detection were similar across the 2009 and 2021 CKD-EPI equations.
Diagnostic performance metrics (sensitivity, specificity, and C-statistics) for CKD detection in risk groups were compared across equations.
Results were similar across all equations, indicating equivalent discriminative ability for CKD detection.
This held across the multiethnic subgroups examined in the study.
Results
Integration of CKD status modestly increased cardiovascular risk estimates, but CV risk classifications were virtually identical across the 2009 and 2021 equations.
CV risk was assessed using SCORE2 and SCORE2 CKD Add-on models.
Results for CV risk categorization were 'virtually identical' across the 2009 and 2021 equations.
Adopting the race-free CKD-EPI equation is 'unlikely to alter CV risk management at the population level.'
Conclusions
The study findings support clinical interchangeability of the 2009 and 2021 CKD-EPI equations and endorse adoption of the race-free equation as an equitable and reliable standard.
The cross-sectional analysis included participants from a large, multiethnic urban European setting (Amsterdam).
The authors conclude that the race-free 2021 equation is 'an equitable and reliable standard for kidney function assessment and CV risk prediction.'
Both CKD and CV risk classifications were described as 'nearly identical' between equations, supporting interchangeability in clinical practice.
What This Means
This research examined whether switching from an older kidney function formula (2009 CKD-EPI) to a newer, race-free formula (2021 CKD-EPI) would change how chronic kidney disease (CKD) and heart disease risk are assessed in a diverse European population. The study analyzed data from over 21,000 adults of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan backgrounds living in Amsterdam. The older formula used a 'race correction' that produced higher kidney function estimates for people identified as Black, while the newer formula treats all patients the same regardless of race or ethnicity.
The researchers found that removing the race correction did lower estimated kidney function for people of African descent (African Surinamese and Ghanaian participants), which led to a small increase in the number of people from those groups classified as having CKD. However, the overall ability to correctly identify who has CKD was nearly identical between the two formulas, with agreement rated as 'almost perfect.' Similarly, when the formulas were used to estimate heart disease risk, the results were virtually the same regardless of which equation was used.
This research suggests that healthcare systems can switch to the newer race-free formula without concern that it will substantially change how patients are classified for kidney disease or cardiovascular risk management. The findings are relevant because using race as a biological variable in medical calculations has been criticized as scientifically problematic and potentially inequitable. This study provides evidence that the newer, race-neutral approach performs just as well clinically while removing a racially based adjustment from routine medical care.
Huisman B, Vosters T, Agyemang C, van den Born B, van Valkengoed I, Vogt L. (2026). 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.. Global heart. https://doi.org/10.5334/gh.1579