An eGFR of 38 mL/min/1.73 m² Corresponds to Stage 3b Chronic Kidney Disease
An estimated glomerular filtration rate (eGFR) of 38 mL/min/1.73 m² corresponds to Stage 3b chronic kidney disease (CKD), which represents moderate to severe decrease in kidney function. 1
Understanding CKD Staging
CKD is classified into stages based primarily on eGFR levels:
- Stage 1: eGFR ≥90 mL/min/1.73 m² with evidence of kidney damage 1
- Stage 2: eGFR 60-89 mL/min/1.73 m² with evidence of kidney damage 1
- Stage 3a: eGFR 45-59 mL/min/1.73 m² (mild to moderate GFR decrease) 1
- Stage 3b: eGFR 30-44 mL/min/1.73 m² (moderate to severe GFR decrease) 1
- Stage 4: eGFR 15-29 mL/min/1.73 m² (severe GFR decrease) 1
- Stage 5: eGFR <15 mL/min/1.73 m² or dialysis (kidney failure) 1
Clinical Implications of Stage 3b CKD
At this stage of kidney disease, several important clinical considerations emerge:
- Increased risk for cardiovascular events and mortality compared to earlier stages 2
- Higher risk of CKD progression to more advanced stages 3
- Need for evaluation and treatment of CKD complications 1
- Medication dosage adjustments may be necessary 1
- Regular monitoring of kidney function is essential 1
Management Priorities for Stage 3b CKD
For patients with Stage 3b CKD (eGFR 38 mL/min/1.73 m²), the following management strategies should be implemented:
- Comprehensive evaluation of the cause of kidney injury 1
- Treatment of modifiable risk factors for CKD progression (hypertension, diabetes, albuminuria) 1
- Assessment for complications such as anemia, metabolic bone disease, and electrolyte abnormalities 1
- Dietary protein intake should be aimed at approximately 0.8 g/kg body weight per day 1
- Consideration of nephrology referral, especially if there is rapid progression or uncertainty about etiology 1
Medication Considerations
Several medication classes require special attention at this stage:
- ACE inhibitors or ARBs are preferred treatments for patients with hypertension and albuminuria 1
- SGLT2 inhibitors should be considered if eGFR ≥20 mL/min/1.73 m² to reduce CKD progression and cardiovascular events 1
- Nonsteroidal mineralocorticoid receptor antagonists may be beneficial if eGFR ≥25 mL/min/1.73 m² 1
- Medication dosing may need adjustment based on reduced kidney function 1
Important Monitoring Parameters
Regular monitoring should include:
- eGFR and urinary albumin-to-creatinine ratio (UACR) at least annually 1
- Blood pressure control 1
- Glycemic control in patients with diabetes 1
- Electrolyte levels, particularly potassium 1
- Signs of disease progression or complications 1
When to Consider Nephrology Referral
Nephrology referral should be considered in the following circumstances:
- Rapidly declining eGFR 1
- Significant albuminuria (>300 mg/g) 1
- Uncertainty about the etiology of CKD 1
- Difficult-to-manage complications (resistant hypertension, electrolyte disorders) 1
- Planning for future renal replacement therapy if progression continues 1
Common Pitfalls to Avoid
- Failing to recognize that an eGFR of 38 represents significant kidney dysfunction that requires active management 3
- Overlooking the increased cardiovascular risk associated with Stage 3b CKD 2
- Delaying diagnosis and appropriate management, which is associated with worse outcomes 3
- Not adjusting medication dosages appropriately for the level of kidney function 1
- Missing opportunities for interventions that could slow disease progression 3