What stage of kidney disease is indicated by a Glomerular Filtration Rate (GFR) of 11?

GFR of 11 Indicates Stage 5 Chronic Kidney Disease (End-Stage Kidney Disease)

A glomerular filtration rate (GFR) of 11 mL/min/1.73 m² definitively classifies as Stage 5 chronic kidney disease (CKD), also known as kidney failure or end-stage kidney disease. 1

Classification of CKD Stages Based on GFR

CKD is staged according to GFR levels as follows:

• Stage 1: GFR ≥90 mL/min/1.73 m² with evidence of kidney damage
• Stage 2: GFR 60-89 mL/min/1.73 m² with evidence of kidney damage
• Stage 3a: GFR 45-59 mL/min/1.73 m²
• Stage 3b: GFR 30-44 mL/min/1.73 m²
• Stage 4: GFR 15-29 mL/min/1.73 m²
• Stage 5: GFR <15 mL/min/1.73 m² or requiring kidney replacement therapy 1

Clinical Implications of Stage 5 CKD

With a GFR of 11 mL/min/1.73 m², this patient has severely decreased kidney function that requires:

1. Immediate nephrology referral - Guidelines clearly state that patients with eGFR <30 mL/min/1.73 m² should be referred to a nephrologist 1

2. Preparation for renal replacement therapy - At this GFR level, the patient is approaching the need for dialysis or transplantation 2

3. Medication adjustments - Many medications require dose adjustment or discontinuation at this level of kidney function 1

4. Close monitoring - The patient requires frequent monitoring (recommended 3-4 times per year) as indicated by the "dark red" risk category in CKD progression grids 1

Mortality and Morbidity Considerations

Stage 5 CKD is associated with significantly increased risks:

• Cardiovascular mortality - CKD is an independent risk factor for cardiovascular events and death 1
• Progression to dialysis dependence - Without intervention, continued decline in kidney function is likely 3
• Uremic complications - Including metabolic acidosis, electrolyte abnormalities, and uremic symptoms 4

Management Priorities

For a patient with GFR of 11 mL/min/1.73 m²:

1. Nephrology consultation is mandatory for specialized care and dialysis planning 1

2. Dietary management - Protein intake should be aimed at 0.8 g/kg body weight per day for non-dialysis dependent patients 1

3. Medication optimization:

   • Consider SGLT2 inhibitors if GFR ≥20 mL/min/1.73 m² 1
   • Adjust or discontinue medications cleared by the kidneys
   • Review for nephrotoxic medications that should be avoided

4. Vascular access planning if dialysis is anticipated

5. Transplant evaluation if the patient is a candidate

Common Pitfalls to Avoid

1. Delayed nephrology referral - This is associated with worse outcomes and should be avoided 5

2. Relying solely on GFR for dialysis initiation - The decision to start dialysis should not be based on GFR alone but should include assessment of uremic symptoms 2

3. Failure to discuss all treatment options - Including hemodialysis, peritoneal dialysis, transplantation, and conservative management 2

4. Inadequate medication review - Failure to adjust medications based on current renal function can lead to adverse effects 5

The patient with a GFR of 11 mL/min/1.73 m² has reached a critical stage of kidney disease requiring urgent specialist care and preparation for kidney replacement therapy or conservative management depending on individual circumstances.