Laboratories may use different equations to calculate eGFR. Equations consider serum creatinine levels and some or all of the following factors: age, sex, body size, and race. Race is not a factor in eGFR equations for children. We consider all eGFR equations when we evaluate chronic kidney disease under listings 6.05 and 106.05.

Examples of eGFR equations include:

• •

  The Modification of Diet in Renal Disease (MDRD) equation (used for adults age 18 or older),

• •

  The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (used for adults age 18 or older), or

• •

  The Bedside Schwartz equation (for children under age 18).

NOTE: Do not calculate the eGFR if the laboratory did not provide it.

Laboratories may report different eGFR values based on a person's race. For example, the report may contain:

• •

  One eGFR value for the person’s identified race,

• •

  One eGFR value for African Americans and a second eGFR value for other races, or

• •

  One eGFR value for other races and an instruction to multiply this value by an adjustment factor (usually recorded next to the eGFR value in the laboratory report) if the person is African American.

On September 23, 2021, the National Kidney Foundation (NKF) and American Society of Nephrology (ASN), published a report recommending that laboratories should not include race in eGFR calculation and reporting.^[1] In response to this recommendation, we will use the unadjusted eGFR value for all persons, regardless of race. Some examples of how laboratories may report the unadjusted eGFR value include “eGFR,” “eGFR Non-African American,” “eGFR Non-Black,” or “eGFR Caucasian.”

If the person is African American, and the laboratory reports:

• •

  An unadjusted eGFR value and an eGFR value for African Americans, use the unadjusted eGFR value.

• •

  An unadjusted eGFR value and an instruction to multiply this value by an adjustment factor if the person is African American, use the unadjusted eGFR value. Do not multiply the eGFR value by the adjustment factor.

Contact the medical source to obtain the unadjusted eGFR if the person is African American and the laboratory reports:

• •

  One eGFR value for African Americans, or

• •

  One eGFR value and it is unclear whether the eGFR value was adjusted for race,

AND

• •

  All of the following conditions apply:

  • –

    There are no other laboratory findings in the medical evidence that satisfy the criteria in listing 6.05A,

    and

  • –

    The person has at least one of the additional impairments required in listing 6.05B, and

  • –

    Using the unadjusted eGFR value may change the determination of the claim.

If a laboratory provides both the urine total protein and urine total creatinine values, it will usually report them using the same units of measurement. In this instance, the laboratory will normally include the UPCR in the report. We accept UPCR values calculated from random (spot) urine samples or timed collections (including 24-hour collections).

If the laboratory does not provide the UPCR, we may calculate the ratio if all of the following apply to the urine total protein and urine total creatinine values:

• •

  Reported in the same units of measurement,

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  Recorded on the same laboratory report, and

• •

  Performed on the same day.

To calculate the UPCR, divide the urine total protein by the urine total creatinine.

NOTE: Use laboratory values from urine tests to calculate the UPCR. Laboratories sometimes report serum creatinine values instead of urine creatinine. Do not use serum creatinine laboratory values to calculate the UPCR.