Advancing CKD Diagnosis: Innovative Methods and Equity in Practice

Clinical advancements in Chronic Kidney Disease (CKD) are reshaping early detection, with novel methods like NORA prompting new research while equity-focused debates challenge traditional frameworks.

Early preprint findings suggest NORA may improve CKD classification in research datasets; current clinical guidelines do not endorse this approach for diagnosis. By employing routinely available non-renal variables (e.g., sociodemographics and comorbidities), the preprint reports higher F1-scores versus baseline models in the studied datasets, indicating better classification performance; these are modeling metrics and do not demonstrate clinical diagnostic benefit. The approach demonstrates research applicability across diverse datasets, as described in the NORA preprint, but any clinical use would require external, prospective validation and regulatory review. In research settings, these methods may enable cross-dataset generalization; any effects on patient management remain unproven and require clinical studies. Here, 'integration' refers to potential cross-dataset generalization of models rather than immediate EHR or clinical integration. If validated prospectively, improved classification could support earlier identification for evaluation or monitoring.

Removing race adjustments from eGFR equations has become a focal point for equity. Consistent with NKF/ASN Task Force recommendations, many centers have adopted the CKD-EPI 2021 race-free equation; these changes can affect staging and management decisions. Peer-reviewed analyses and task force reports indicate that removing race coefficients can change CKD staging and referral patterns; the cited preprint adds supportive analyses but should be interpreted cautiously. These shifts may alter staging thresholds, referral timing, and medication dosing, depending on local protocols and patient context. These updates may influence staging thresholds, referral timing, and medication dosing decisions in some settings. Reclassification under race-free eGFR can change CKD staging and eligibility for referral or transplant evaluation, highlighting disparities observed under prior approaches. Achieving equity in CKD diagnosis remains a central concern, particularly when racial disparities complicate existing frameworks.

Summary

• NORA is at a preliminary, preprint stage; reported gains in F1 reflect modeling performance in research datasets, not clinical diagnostic accuracy.
• Before any clinical use, approaches like NORA would require external, prospective validation and regulatory review, and they are not endorsed by current clinical guidelines.
• Race-free eGFR (CKD-EPI 2021) adoption, aligned with NKF/ASN recommendations, can shift CKD staging and influence referrals and dosing decisions, with implications for equity.
• Equity considerations span algorithm development and kidney function estimation; careful interpretation and standardized processes are needed to avoid unintended harms.