ArticleNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2026
Changing from the CKD-EPI to the EKFC creatinine equation to estimate glomerular filtration rate in adults in a Northern European health system.
Article in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Comment on: retrospective and comparative assessment of MDRD, CKD-EPI, and EKFC equations for estimating glomerular filtration rate in a clinically heterogeneous hospital population.International urology and nephrology · 2026Article
- Impact of Equation Choice on Models Assessing the Association Between Lipoprotein(a) and Estimated Glomerular Filtration Rate in Adult Patients Without Chronic Kidney Disease.Diseases (Basel, Switzerland) · 2026Article
- Similar predictive performance and clinical utility of the Kidney Failure Risk Equation using EKFC or CKD-EPI estimated glomerular filtration rate.Clinical kidney journal · 2026Article
- Evaluating Long-Term Outcomes Across eGFR Equations in Older Adults.Kidney international reports · 2026Article
- Prevalence of Hyperkalemia in a Contemporary European Cohort According to EKFC eGFR Categories.Diagnostics (Basel, Switzerland) · 2026Article
- Combined use of ultrasonography and point shear wave elastography for the assessment of renal diseases.Frontiers in medicine · 2026Article
- When equations disagree: the impact of creatinine-based eGFR in CKD diagnosis and reclassification.BMC nephrology · 2025Article
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Authors and funding
12 authors.
Funding
Abstract
backgroundThe European Kidney Function Consortium (EKFC) 2021 equation to estimate GFR performs as well or better than the CKD-EPI 2009 equation in predominantly White adult European populations, with less bias and greater accuracy against measured GFR. This study explores how changing from the CKD-EPI to the EKFC equation in a large European health system may affect disease distribution, prognosis, and clinical decisions.
methodsWe studied >1.7 million adults in Stockholm undergoing routine care during 2006-2021. We compared eGFR values and reclassification across KDIGO GFR categories when changing from the CKD-EPI to EKFC equation and examined associations of eGFR and reclassification with risk for kidney failure with replacement therapy (KFRT), mortality, and major adverse cardiovascular events (MACE) using Cox models. We also modeled the impact of eGFR equation change on clinical decisions such as nephrology referral or medication eligibility/contraindication.
resultsEKFC yielded modestly lower eGFR values than CKD-EPI by a median (IQR) of -4.9 (-8.3 to -2.2) ml/min/1.73 m². As a result, CKD G3-G5 prevalence rose from 4.5% to 6.2%. Both equations strongly predicted KFRT, mortality, and MACE. Participants reclassified to lower eGFR categories were older; after adjustment for age, participants had similar risks of mortality and MACE to those not reclassified and a lower risk of KFRT. Changing to the EKFC equation would impact clinical decisions at low eGFR thresholds, such as nephrology referrals (22% higher), eligibility for SGLT2 is (39% higher), or contraindication for spironolactone in heart failure (26% higher).
conclusionsAdopting the EKFC equation in this Northern European health system would modestly lower eGFR estimates, increasing the prevalence of moderate/severe CKD and affecting clinical classification and decisions. eGFR by both equations strongly predicted outcomes, but individuals reclassified to a lower eGFR category by EKFC did not have consistent associations across outcomes.
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