From the Guidelines
For stage 3 chronic kidney disease (CKD), the estimated glomerular filtration rate (eGFR) typically ranges between 30-59 mL/min/1.73m², as defined by the most recent guidelines 1.
Definition and Classification
The definition and classification of CKD have evolved over time, with the most recent guidelines suggesting that stage 3 CKD be subdivided into two categories: stage 3a (eGFR 45-59 mL/min/1.73m²) and stage 3b (eGFR 30-44 mL/min/1.73m²) 1.
Management and Monitoring
Management of stage 3 CKD should focus on slowing disease progression and addressing cardiovascular risk factors, with regular monitoring of eGFR and urine albumin-to-creatinine ratio every 6-12 months to track disease progression and guide therapy adjustments 1.
Blood Pressure Control and Medications
Blood pressure control is essential, with a target of <130/80 mmHg for most patients, and ACE inhibitors or ARBs (such as lisinopril 10-40 mg daily or losartan 50-100 mg daily) are preferred first-line agents as they provide both blood pressure control and kidney protection by reducing proteinuria and intraglomerular pressure 1.
Lifestyle Modifications and Glycemic Control
Lifestyle modifications are crucial, including sodium restriction (<2g/day), moderate protein intake (0.8g/kg/day), regular exercise, smoking cessation, and weight management, and glycemic control for diabetic patients (target HbA1c ~7%) helps slow progression 1.
SGLT2 Inhibitors and GLP-1 RAs
SGLT2 inhibitors like empagliflozin 10-25 mg daily or dapagliflozin 10 mg daily should be considered as they've shown kidney-protective benefits even in non-diabetic CKD, and GLP-1 RAs are suggested because they reduce risks of CVD events and hypoglycemia and appear to possibly slow CKD progression 1.
From the Research
Estimated Glomerular Filtration Rate (eGFR) for Stage 3 Chronic Kidney Disease (CKD)
- The eGFR for Stage 3 CKD is estimated to be between 30 and 59 ml/min/1.73 m2 2, 3, 4.
- This range is based on the Kidney Disease Outcomes Quality Initiative (K/DOQI) classification and is used to diagnose and manage CKD 2, 3.
- Studies have shown that patients with Stage 3 CKD are at increased risk of cardiovascular disease and kidney disease progression, and that early intervention and management can help slow disease progression 2, 5, 3, 6, 4.
Key Findings
- A study of 26,851 patients with Stage 3 CKD found that the annual eGFR decline was significantly reduced following a CKD diagnosis, from 3.20 ml/min/1.73 m2 to 0.74 ml/min/1.73 m2 2.
- Another study found that angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) can help reduce the risk of kidney disease progression and cardiovascular disease in patients with early CKD, including those with Stage 3 CKD 5.
- A review of studies on the effectiveness of ACEi and ARB in patients with Stage 1-3 CKD found that there is currently insufficient evidence to determine their effectiveness in this population 5.
- Studies have also shown that monitoring of serum creatinine and potassium is important in patients with CKD, particularly those taking ACEi or ARB 6.