From the Guidelines
A kidney function of 37% indicates moderate chronic kidney disease (CKD), typically classified as Stage 3a, and requires careful management to prevent further decline, including regular monitoring, dietary modifications, and avoidance of nephrotoxic medications, as supported by the most recent guidelines from the Kidney Disease: Improving Global Outcomes (KDIGO) 1.
Key Considerations
- Blood pressure control is essential, often with medications like ACE inhibitors (such as lisinopril 10-40mg daily) or ARBs (such as losartan 50-100mg daily), which help protect kidney function.
- Dietary modifications are important, including reducing sodium to less than 2,300mg daily, moderating protein intake to about 0.8g per kg of body weight, and limiting phosphorus and potassium if your levels are elevated.
- Regular monitoring of kidney function through blood tests (creatinine, eGFR, electrolytes) every 3-6 months is necessary to track disease progression.
- Avoiding nephrotoxic medications like NSAIDs (ibuprofen, naproxen) and ensuring proper hydration are crucial.
- Managing underlying conditions such as diabetes (target HbA1c below 7%) and high cholesterol is vital for kidney protection.
Monitoring and Management
- The Canadian Society of Nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management suggests that for people with CKD but without diabetes, eGFR be determined when there is an important change in health status and when considering prescribing a medication affected by eGFR 1.
- The European Society of Cardiology working group on cardiovascular pharmacotherapy recommends accurate determination of eGFR using equations based on serum creatinine measurement, such as the CKD-EPI equation, to adjust dose requirements of renally cleared drugs 1.
Conclusion is not allowed, so the answer will be ended here.
From the FDA Drug Label
The secondary endpoints of the study were change in proteinuria, change in the rate of progression of renal disease, and the composite of morbidity and mortality from cardiovascular causes ... Compared with placebo, losartan significantly reduced proteinuria by an average of 34%, an effect that was evident within 3 months of starting therapy, and significantly reduced the rate of decline in glomerular filtration rate during the study by 13%, as measured by the reciprocal of the serum creatinine concentration
The implications of impaired renal function with a glomerular filtration rate (GFR) of 37% are not directly stated in the provided text. However, the study shows that losartan can reduce the rate of decline in GFR by 13% in patients with impaired renal function.
- Key points:
- Losartan reduces the rate of decline in GFR.
- The study does not provide information on the specific implications of a GFR of 37%. 2
From the Research
Implications of Impaired Renal Function
Impaired renal function with a glomerular filtration rate (GFR) of 37% has several implications, including:
- Increased risk of kidney function decline, as seen in patients with chronic kidney disease (CKD) 3
- Higher risk of end-stage renal disease (ESRD) or death, particularly in patients with diabetic nephropathy 4
- Potential benefits from combination therapy with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in reducing proteinuria and slowing kidney function decline 5, 6
- Importance of monitoring and managing clinical risk factors, such as hypertension, proteinuria, and diabetes, to slow kidney function decline 7, 3
Clinical Risk Factors
Clinical risk factors associated with impaired renal function and kidney function decline include:
- Hypertension, which can increase the risk of kidney function decline and ESRD 7, 3
- Proteinuria, which is a marker of kidney damage and can increase the risk of kidney function decline and ESRD 7, 3
- Diabetes, which can increase the risk of kidney function decline and ESRD, particularly in patients with diabetic nephropathy 4
- Older age, which can increase the risk of kidney function decline and ESRD 7, 3
Treatment Options
Treatment options for impaired renal function and kidney function decline include:
- Combination therapy with ACEIs and ARBs, which can reduce proteinuria and slow kidney function decline in patients with nondiabetic CKD 6
- Monotherapy with ACEIs or ARBs, which can also reduce proteinuria and slow kidney function decline, but may not be as effective as combination therapy 5, 4
- Lifestyle modifications, such as blood pressure control, protein restriction, and smoking cessation, which can also help slow kidney function decline 7, 3