Adopting Race-Free Estimated Glomerular Filtration Rate for Unifying Medication-Related Decision-Making: An Opinion of the Nephrology Practice and Research Network of the American College of Clinical Pharmacy

Pharmacists play a critical role in optimizing medication use, especially in vulnerable populations such as those with chronic kidney disease (CKD). Despite strong evidence and recent guideline endorsements, many pharmacists continue to rely on the Cockcroft–Gault (C-G) equation for medication dosing. This opinion paper issues a call to action for the widespread adoption of a race-free, body surface area–adjusted estimated glomerular filtration rate (eGFR_BSAadj) for medication-related decision-making, as endorsed by the 2024 Kidney Disease: Improving Global Outcomes CKD guidelines and the National Kidney Foundation and the American Society of Nephrology Taskforce. Persistent variability in pharmacy practice, institutional protocols, and pharmacy education underscores the need for coordinated change. We urge health systems to integrate eGFR_BSAadj into electronic health records and clinical decision support to enhance medication decision-making; institutions to align protocols with contemporary eGFR-based prescribing standards; pharmacy educators to contemporize and standardize education on kidney function assessment and medication dosing; and regulatory bodies to update licensure and board examinations. The pharmacy profession must act decisively in order to align with evidence-based, equitable kidney-related dosing practices and ensure optimal medication management for all patients.