Management of a Patient with eGFR of 66 mL/min/1.73 m²
An eGFR of 66 mL/min/1.73 m² indicates mildly decreased kidney function (CKD stage 2) and requires regular monitoring but does not necessitate dose adjustments for most medications or specific interventions at this time. 1
Classification and Risk Assessment
- An eGFR of 66 mL/min/1.73 m² falls into CKD stage 2 (60-89 mL/min/1.73 m²), classified as mildly decreased GFR with evidence of kidney damage 1
- This level of kidney function is associated with a slightly increased risk of cardiovascular events compared to normal kidney function (eGFR ≥90 mL/min/1.73 m²) 2, 3
- Even mildly decreased eGFR can be associated with increased risk of adverse cardiovascular outcomes, especially when proteinuria is present 4
Recommended Monitoring
- Annual assessment of kidney function with serum creatinine and eGFR calculation 1
- Annual quantitative assessment of urinary albumin excretion (urine albumin-to-creatinine ratio or UACR) 1
- Blood pressure monitoring at each clinical visit to maintain target <130/80 mmHg 1
- Assessment of cardiovascular risk factors, as mildly decreased eGFR is independently associated with increased atherosclerotic burden 3
Medication Considerations
- At this eGFR level (66 mL/min/1.73 m²), most medications do not require dose adjustments 1, 5
- Metformin can be safely used without dose adjustment (contraindicated only when eGFR <30 mL/min/1.73 m²) 5
- Fenofibrate can be used at normal doses (dose reduction required only when eGFR <60 mL/min/1.73 m²) 1
- ACE inhibitors or ARBs can be used at standard doses with appropriate monitoring 1
Prevention of Further Kidney Function Decline
- Optimize glycemic control if the patient has diabetes 1
- Maintain blood pressure control, preferably with ACE inhibitors or ARBs if hypertension and albuminuria are present 1
- Address modifiable cardiovascular risk factors (smoking, obesity, sedentary lifestyle) 1
- Avoid nephrotoxic medications when possible, including prolonged use of NSAIDs 1
Follow-up Recommendations
- Monitor kidney function (serum creatinine and eGFR) annually 1
- Increase monitoring frequency to every 6 months if there is evidence of progressive decline in eGFR or if the patient has diabetes 1
- Monitor for development of proteinuria, which would increase cardiovascular and renal risk 4
- If eGFR declines to <60 mL/min/1.73 m², increase monitoring frequency and evaluate for complications of CKD 1
Special Considerations
- For patients with heart failure, an eGFR of 66 mL/min/1.73 m² should not limit the use of guideline-directed medical therapies 6
- For older adults (≥65 years), this mildly decreased eGFR may represent age-related decline rather than pathological kidney disease, but still warrants monitoring 1, 7
- When administering iodinated contrast for imaging procedures, standard precautions should be followed, but this level of kidney function does not require special preparation 5