Evaluation of the CKD-EPI 2021 creatinine equation using laboratory data: Considerations for practice changes among clinical laboratories in British Columbia, Canada

•Comparing race-free CKD-EPI 2009 and 2021 equations in British Columbia, Canada.•The new CKD-EPI 2021 equation resulted in reclassifying 11.86% of individuals.•The new CKD-EPI 2021 equation primarily affected the stage G3a to G2.•The reclassification was statistically significant for the non-renal versus renal patients.•The study emphasizes the potential impact of adopting the CKD-EPI 2021 equation. Clinical laboratories in British Columbia, Canada implemented the CKD-EPI 2009 equation without the race variable for estimated glomerular filtration rate (eGFR) reporting since 2014. As more clinical laboratories adopt the new CKD-EPI 2021 equation, the study aims to compare these two race-free CKD-EPI eGFR equations using the laboratory data from a large tertiary hospital in BC and evaluate the impact on reclassification of eGFR category. Serum/plasma creatinine results and demographic data were collected from Vancouver General Hospital laboratory. The CKD-EPI 2009 without the race variable and CKD-EPI 2021 equations were computed. eGFR and its distributions were compared and reclassification of eGFR category was assessed across the full cohort and in specific patient populations. The analysis included 58,763 patients. The median age was 57 years, with women comprising 51 % of the population. The median of eGFR changed from 85 to 90 mL/min/1.73 m2 using the CKD-EPI 2009 equation without the race variable and the CKD-EPI 2021 equation, respectively. The CKD-EPI 2021 equation reclassified 11.86 % of patients, mainly from G3a (45–59 mL/min/1.73 m2) to G2 (60–89 mL/min/1.73 m2). There was statistical significance between the non-renal and the renal population reclassified from G5 (