Is an eGFR of 62 bad for a 61-year-old female?

Is an eGFR of 62 mL/min/1.73 m² Bad for a 61-Year-Old Female?

An eGFR of 62 mL/min/1.73 m² in a 61-year-old female represents mildly reduced kidney function that is not inherently "bad" but requires assessment for albuminuria and monitoring of trajectory, as this level alone does not significantly increase cardiovascular or mortality risk in the absence of kidney damage markers. 1

Understanding Age-Adjusted Kidney Function

• Normal GFR in young adults is approximately 120-130 mL/min/1.73 m² but declines physiologically with age beginning in the third or fourth decade of life 2
• By the sixth decade, GFR commonly declines by 1-2 mL/min per year as a normal aging process 2
• An eGFR of 62 mL/min/1.73 m² represents retention of more than half of normal adult kidney function 1
• This value places your patient just above the critical threshold of 60 mL/min/1.73 m², which is the cutoff for defining chronic kidney disease (CKD) 2

Clinical Staging and Risk Stratification

Your patient is in Stage 2 CKD (G2: 60-89 mL/min/1.73 m²) if kidney damage markers are present, or has normal kidney function for age if no damage markers exist. 1

The critical next step is assessing for albuminuria:

• Measure urinary albumin-to-creatinine ratio (UACR) on a random spot urine sample 2
• Normal UACR is <30 mg/g creatinine 2
• Albuminuria (UACR ≥30 mg/g) is the principal marker of kidney damage and dramatically increases cardiovascular and kidney disease progression risk even with preserved eGFR 1
• If UACR is elevated, confirm with 2 of 3 specimens collected within 3-6 months due to high biological variability 2

Cardiovascular and Mortality Risk Assessment

An eGFR of 62 mL/min/1.73 m² is far above the risk thresholds for increased mortality and cardiovascular complications. 1

Key risk thresholds to understand:

• eGFR ≥60 mL/min/1.73 m²: No significantly increased cardiovascular or mortality risk from kidney function alone 1
• eGFR 45-59 mL/min/1.73 m²: Moderately increased risk 2
• eGFR <45 mL/min/1.73 m²: Substantially increased risk of complications and mortality 2
• The presence of CKD (eGFR <60 mL/min/1.73 m²) confers approximately 16% increase in cardiovascular mortality, but this risk is heavily modified by albuminuria status 2

Medication Management Considerations

At eGFR 62 mL/min/1.73 m², most medications do not require dose adjustment, but you should use the CKD-EPI equation for accurate assessment. 2

• Drug accumulation due to reduced renal excretion is the most important cause of adverse drug reactions in older adults 2
• The CKD-EPI equation is recommended for estimating eGFR in adults of any age and should be used instead of older Cockcroft-Gault calculations 2, 3
• Monitor renal function regularly, as creatinine-based equations can misclassify kidney disease by one stage in >30% of older adults due to reduced muscle mass 2
• Consider cystatin C-based eGFR if there is concern about accuracy, as CKD-EPI creatinine-cystatin C is more accurate than creatinine-based equations in older people 2

Essential Monitoring Strategy

Serial eGFR measurements over time are more informative than a single value for risk stratification in elderly patients. 1

Monitor for:

• Rate of eGFR decline: If declining >4-8 mL/min per year, this suggests accelerated kidney disease requiring intervention 2
• Blood pressure control: Uncontrolled systolic blood pressure accelerates GFR deterioration 2
• Diabetes status: If diabetic, screen for retinopathy as its absence with kidney disease suggests alternative causes 2
• Urinary sediment abnormalities: Active sediment (red/white blood cells, casts) or rapidly increasing albuminuria suggests non-diabetic kidney disease requiring nephrology referral 2

Common Pitfalls to Avoid

• Do not assume kidney disease based on eGFR alone: Without albuminuria or other kidney damage markers, an eGFR of 62 may represent normal aging rather than disease 1
• Do not ignore albuminuria: Even with eGFR >60, albuminuria confers a 50% increase in cardiovascular risk (microalbuminuria) or 350% increase (macroalbuminuria) 2
• Do not use serum creatinine alone: In older females with reduced muscle mass, serum creatinine may appear normal despite reduced kidney function 2
• Do not overlook trajectory: A stable eGFR of 62 over years is vastly different from one declining from 90 to 62 over months 1