From the Guidelines
A GFR of 58 mL/min/1.73m² indicates Stage 3a chronic kidney disease (CKD), representing moderate kidney damage with moderately decreased kidney function, and requires specialized care and regular monitoring every 6-12 months. According to the National Kidney Foundation practice guidelines for chronic kidney disease 1, a GFR level less than 60 mL/min per 1.73 m2 represents loss of half or more of the adult level of normal kidney function. At this stage, it is essential to control blood pressure, manage diabetes if present, and avoid nephrotoxic medications.
Key Management Steps:
- Controlling blood pressure (target <130/80 mmHg)
- Managing diabetes if present (target HbA1c <7%)
- Avoiding nephrotoxic medications like NSAIDs (ibuprofen, naproxen)
- Considering medications like ACE inhibitors or ARBs to protect kidney function, as recommended by the guidelines 1
Lifestyle Modifications:
- Maintaining a healthy weight
- Exercising regularly
- Following a kidney-friendly diet (moderate protein, low sodium, controlled potassium and phosphorus)
- Stopping smoking if applicable
- Staying well-hydrated, but avoiding excessive fluid intake It is crucial to note that a GFR level of 58 mL/min/1.73m² means the kidneys are functioning at about 58% of normal capacity, and while this is concerning, proper management can help slow progression to more advanced kidney disease, as emphasized by the guidelines 1.
From the FDA Drug Label
Impaired renal function decreases elimination of lisinopril, which is excreted principally through the kidneys, but this decrease becomes clinically important only when the glomerular filtration rate is below 30 mL/min. Above this glomerular filtration rate, the elimination half-life is little changed With greater impairment, however, peak and trough lisinopril levels increase, time to peak concentration increases and time to attain steady state is prolonged [see Dosage and Administration (2. 4)].
The patient's GFR of 58 is above the threshold of 30 mL/min, where the elimination of lisinopril becomes clinically important. Therefore, no dose adjustment is necessary based on the information provided in the drug label 2.
From the Research
GFR 58 Overview
- A GFR (Glomerular Filtration Rate) of 58 is considered to be stage 3 chronic kidney disease (CKD) according to the National Institute of Diabetes and Digestive and Kidney Diseases 3.
- At this stage, the kidneys are still able to filter waste from the blood, but not as efficiently as healthy kidneys.
- Patients with a GFR of 58 may experience symptoms such as fatigue, swelling, and frequent urination.
Treatment and Management
- Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are commonly used to treat patients with CKD, including those with a GFR of 58 4, 5, 6.
- These medications help to slow the progression of CKD by reducing proteinuria and blood pressure.
- However, the use of ACEIs and ARBs in patients with advanced CKD is still a topic of debate, with some studies suggesting that they may be underprescribed in this population 4, 7.
Monitoring and Follow-up
- Regular monitoring of kidney function, including GFR, is essential for patients with CKD 3.
- Patients with a GFR of 58 should be monitored regularly for signs of kidney disease progression, such as a decrease in GFR or an increase in proteinuria.
- Lifestyle modifications, such as a healthy diet and regular exercise, can also help to slow the progression of CKD.
Clinical Considerations
- The decision to use ACEIs or ARBs in patients with a GFR of 58 should be made on a case-by-case basis, taking into account the individual patient's medical history and comorbidities 6.
- Patients with CKD should be closely monitored for potential side effects of ACEIs and ARBs, such as hyperkalemia and hypotension 6.
- Further research is needed to determine the optimal treatment strategies for patients with CKD, including those with a GFR of 58 4, 7.