Did You Actually Have CKD?
You may not have met the formal diagnostic criteria for CKD when first diagnosed, and you may still not meet them now, depending on whether your eGFR dips have been confirmed with repeat testing over the required 3-month period.
Understanding the Diagnostic Criteria for CKD
The diagnosis of CKD requires persistence of abnormalities for at least 3 months, not just a single abnormal test 1. This is a critical distinction that many providers and patients overlook. CKD is defined by either:
- eGFR <60 mL/min/1.73 m² persisting for ≥3 months, OR 1
- Evidence of kidney damage (such as albuminuria with UACR ≥30 mg/g) persisting for ≥3 months, regardless of eGFR 1
Why Your Case Is Questionable
Your situation raises several red flags about whether CKD was appropriately diagnosed:
Your eGFR was in the 60s initially - This is technically Stage 2 CKD, but Stage 2 CKD requires evidence of kidney damage (like albuminuria) to be diagnosed, not just the eGFR number alone 1. An eGFR of 60-89 mL/min/1.73 m² without albuminuria or other kidney damage markers does not constitute CKD 1.
Your uACR has always been normal (<30 mg/g) - This means you have never had documented kidney damage by the most sensitive marker available 1.
Your eGFR has only "dipped into the 50s" occasionally - Biological variability in creatinine and eGFR is common 1. Factors like exercise within 24 hours, dehydration, infection, fever, marked hyperglycemia, or even dietary protein intake can temporarily lower eGFR 1. Two measurements at least 3 months apart are required to confirm chronicity 1, 2.
What Should Have Been Done
According to guidelines, your provider should have:
- Confirmed chronicity by repeating eGFR measurements at least 3 months apart to document persistent eGFR <60 mL/min/1.73 m² 1, 2
- Documented kidney damage through albuminuria testing, with two of three UACR specimens collected within 3-6 months being abnormal (≥30 mg/g) before confirming albuminuria 1
- Ruled out acute causes of eGFR decline, such as volume depletion, nephrotoxic medications (NSAIDs, certain antibiotics), or acute illness 1, 2
The Reality: You May Never Have Had CKD
If your eGFR measurements in the 50s were not confirmed on repeat testing 3+ months later, and your uACR has consistently been normal, you likely do not meet diagnostic criteria for CKD 1, 3. The occasional dips into the 50s could represent:
- Normal biological variation in creatinine production and eGFR calculation 1
- Transient prerenal factors like dehydration or medication effects 1, 2
- Laboratory variability in creatinine measurement 2
What You Should Do Now
To clarify your true kidney status:
- Review all historical eGFR values to determine if you have ever had two measurements <60 mL/min/1.73 m² that were at least 3 months apart 2, 3
- Confirm your most recent eGFR with repeat testing if it's been in the 50s, waiting at least 3 months between measurements 2
- Ensure UACR testing has been performed on at least two occasions, as this is essential for both diagnosis and risk stratification 1, 4
- Consider cystatin C-based eGFR if there's uncertainty, as creatinine-based eGFR can be affected by muscle mass, diet, and other non-kidney factors 2
Common Pitfall: Overdiagnosis of CKD
Your case illustrates a common clinical pitfall: diagnosing CKD based on a single eGFR measurement or mild eGFR reduction without confirming chronicity or documenting kidney damage 3, 5. This leads to unnecessary patient anxiety, potentially inappropriate medication adjustments, and healthcare costs without clear benefit 3.
The key message: An eGFR in the 60s with normal uACR and no other kidney damage markers does not constitute CKD 1. Even eGFR in the 50s requires confirmation over time and ideally evidence of kidney damage to diagnose CKD 1, 3.