October 02, 2026
Article By: Andrew Bzowyckyj, PharmD, BCPS, CDCES and M.J. Lewis
A new consensus statement endorsed by five major U.S. pharmacy organizations recommends moving from the long-standing Cockcroft-Gault estimated creatinine clearance equation to the race-agnostic 2021 CKD-EPI eGFR equation, adjusted for body surface area, for medication-related decisions.
Why the Change?
Cockcroft-Gault has guided medication dosing for nearly 50 years, but its limitations are well recognized. Developed from a small group of White males, it depends on highly variable body weight calculations and predates standardized serum creatinine testing, which can produce inconsistent estimates and dosing decisions.
By contrast, the 2021 CKD-EPI equation was validated in larger, more diverse populations, excludes race, and aligns with current laboratory standards.
Recent studies also show that, when adjusted for body surface area, the 2021 CKD-EPI equation more accurately predicts clearance of four high-stakes, renally eliminated medications.1-4
What Does This Mean for Clinical Practice?
As organizations adopt this recommendation, clinicians can expect broader use of the 2021 CKD-EPI equation in medication decision-making and patient care protocols.
Key benefits include:
- More consistent medication dosing decisions.
- Improved patient safety and medication effectiveness.
- Reduced practice variation across care teams.
- Support for more equitable, race-agnostic care.
Looking Ahead: Recommended Implementation Steps
- Engage your Chief Pharmacy Officer and clinical informatics leadership to assess your current EHR configuration and identify the scope of changes required to surface eGFR as the default kidney function metric in medication related decision support tools.
- Bring the consensus statement to your Pharmacy and Therapeutics Committee for formal review and adoption of a transition timeline.
- Develop a clinician education plan in advance of go-live date, with particular attention to high-prescribing services where renally dosed medications are used frequently.
- Review your health equity reporting to identify whether the transition to race-agnostic eGFR can be incorporated into existing equity initiatives or quality improvement programs.
The science is settled and the consensus is clear: the 2021 CKD-EPI eGFR equation, adjusted for body surface area, should become the preferred standard for medication-related kidney function assessment. For healthcare professionals, understanding this transition will be important to supporting safe medication use, effective interdisciplinary care, and improved patient outcomes.
To access additional resources or to join the conversation, contact imed.community@kidney.org.
