What does an estimated Glomerular Filtration Rate (eGFR) of 60 indicate in the context of Chronic Kidney Disease (CKD)?

From the Guidelines

An eGFR of 60 ml/min/1.73m² indicates mild kidney function reduction, classified as Stage 3a chronic kidney disease (CKD), according to the most recent guidelines 1. This means your kidneys are functioning at about 60% of normal capacity but can still effectively filter waste from your blood. At this stage, you may not experience symptoms, but it's essential to address underlying causes to prevent progression.

Key Considerations:

• Monitor your blood pressure (aim for below 130/80 mmHg) to reduce the risk of cardiovascular disease and CKD progression 1.
• Control blood sugar if diabetic, as hyperglycemia can exacerbate kidney damage 1.
• Maintain a healthy weight, avoid nephrotoxic medications like NSAIDs, limit dietary sodium, and stay well-hydrated to reduce the risk of CKD progression 1.
• Regular follow-up with your healthcare provider every 6-12 months is recommended to track kidney function through blood and urine tests 1. The eGFR calculation considers factors like age, sex, race, and serum creatinine levels to estimate how well your kidneys filter blood.

Treatment and Management:

• The degree of albuminuria may influence the choice of antihypertensive or glucose-lowering medications 1.
• Observed history of eGFR loss and cause of kidney damage may also affect treatment decisions 1.
• Metformin should be considered the first-line treatment for patients with type 2 diabetes, including those with CKD, unless contraindicated 1.
• SGLT2 inhibitors and GLP-1 RAs may be considered for patients with type 2 diabetes and CKD who require additional therapy to attain target A1C or cannot use or tolerate metformin 1.

From the Research

Definition of Chronic Kidney Disease

• Chronic kidney disease (CKD) is defined as a persistent abnormality in kidney structure or function, such as a glomerular filtration rate (GFR) <60 mL/min/1.73 m2 or albuminuria ≥30 mg per 24 hours, for more than 3 months 2.
• The estimated GFR (eGFR) is used to predict the outcome of CKD, recognizing its robust association with renal disease progression and the eventual need for dialysis 3.

eGFR of 60

• An eGFR of 60 mL/min/1.73 m2 is considered the threshold for CKD stage 3, indicating a moderate decrease in kidney function 4.
• However, using the same level of eGFR to define CKD regardless of patient age may classify many elderly people with a normal physiological age-related eGFR decline as having a disease 5.
• A study found that requiring two eGFRs <60 mL/min/1.73 m2 more than 3 months apart may reduce the identification of people without chronic disease, but increase the identification of those who ultimately have progression of CKD or require renal replacement therapy (RRT) 6.

Implications of eGFR of 60

• Patients with an eGFR of 60 mL/min/1.73 m2 should be monitored for complications of CKD, such as hyperkalemia, metabolic acidosis, hyperphosphatemia, vitamin D deficiency, secondary hyperparathyroidism, and anemia 2.
• Optimal management of CKD includes cardiovascular risk reduction, treatment of albuminuria, avoidance of potential nephrotoxins, and adjustments to drug dosing 2.
• Patients at high risk of CKD progression, such as those with an eGFR <30 mL/min/1.73 m2, albuminuria ≥300 mg per 24 hours, or rapid decline in eGFR, should be promptly referred to a nephrologist 2.