A-092 Trends in Laboratory Communications Utilized in the Implementation of the Race-Free CKD-EPI 2021 Estimated Glomerular Filtration Rate (eGFR) Equation
Authors: Luby S 
Published: September 2023

Abstract

Background
The National Kidney Foundation (NKF) established a Laboratory Engagement Working Group (WG) that issued strategies for implementing the race-free CKD-EPI 2021 eGFR equation following the recommendation from the National Kidney Foundation/American Society for Nephrology Joint Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases. These guidelines covered four areas of implementation including communication, assay selection, programming, and reporting. Regarding communication, the NKF-WG recommendations identified six categories of stakeholders that should be included in communications: physicians and advance practitioners, pharmacists, clinical researchers, patients, patient advocates, and dietitians and nutritionists. This research evaluated the alignment of laboratory communications and inclusion of specific stakeholders during implementation of the CKD-EPI 2021 equation with recommendations from the NKF Laboratory Engagement Working Group. Additionally, the research sought to identify if concerns of racial bias associated with previous equations were communicated to stakeholders.

Methods
An anonymous, web-based, cross-sectional survey of laboratory directors in the United States was conducted from November 1st through November 29th, 2022. The call for participants was distributed widely to the membership of the American Society for Clinical Laboratory Science (ASCLS) and the American Association for Clinical Chemistry (AACC). Participants were asked to denote if they had implemented the CKD-EPI 2021 equation, to identify communication methods utilized during implementation, and to identify key stakeholders included in communications. Participants were also asked to indicate if communications included information regarding concerns of racial bias associated with previous eGFR equations.

Results
In total, there were 34 survey participants, with 32 completed submissions. Participants represented 19 states, with 5 states having 2 or more participants. Of the completed submissions, 87.5% (n = 28) of respondents reported implementing the CKD-EPI 2021 equation. Of those respondents, 100% reported issuing communications to physicians and advance practitioners. 71.4% (n = 20) of respondents reported issuing communication to pharmacists, 32.1% (n = 7) included clinical researchers, and 14.3% (n = 4) included dieticians and nutritionists. The most common method of communication directed to the patient care teams was through an official laboratory memo 82.1% (n = 23), followed by direct email 64.8% (n = 18). Notably, only 10.7% (n = 3) of respondents reported issuing communication to patients, however 25.0% (n = 7) of respondents stated that the equation change was noted in the patient’s medical record upon receiving an eGFR value calculated using the updated equation. Of the participants who implemented the equation change, 64.8% (n = 18) reported addressing concerns of racial bias with previous equations in communications with physicians and advanced providers. 42.8% (n = 12) included this information in communications with pharmacists, and only 10.7% (n = 3) reported sharing this information with patients.

Conclusion
A majority of participating laboratories did not include patients as stakeholders in communications during CKD-EPI 2021 implementation, highlighting a lack of alignment with NKF-WG recommendations. Further, and in contrast to physician communications, a majority of laboratories declined to include information regarding potential racial bias associated with previous eGFR equations in their patient communications.