CKD Stage Classification for eGFR 54
An eGFR of 54 mL/min/1.73 m² represents Stage 3A Chronic Kidney Disease, characterized by mild to moderate decrease in kidney function. 1
Stage 3A Definition and Classification
Stage 3A CKD is defined as eGFR 45-59 mL/min/1.73 m², which represents a mild to moderate decrease in kidney function. 1
This stage falls within the broader Stage 3 CKD category (eGFR 30-59 mL/min/1.73 m²), but the subdivision into 3A and 3B is clinically important because these subgroups carry different risks for progression and adverse outcomes. 1, 2
Stage 3A patients have significantly lower risk of progression to kidney failure compared to Stage 3B patients (eGFR 30-44 mL/min/1.73 m²), with Stage 3B carrying approximately 3-fold higher risk of renal dysfunction progression. 2
Clinical Significance and Risk Stratification
At eGFR 54, the patient has lost approximately half of normal adult kidney function, as normal GFR in young adults is approximately 120-130 mL/min/1.73 m². 1
The degree of albuminuria is critical for complete risk stratification at this eGFR level, as albuminuria independently predicts CKD progression, cardiovascular events, and mortality regardless of eGFR. 1, 3
Patients with eGFR 54 and no albuminuria (UACR <30 mg/g) are at moderate risk, while those with microalbuminuria (UACR 30-300 mg/g) or macroalbuminuria (UACR >300 mg/g) are at high to very high risk for progression. 1, 2
Macroalbuminuria increases the risk of progression by 3-fold (HR 3.06), while microalbuminuria increases risk by 2-fold (HR 1.99) in Stage 3 CKD patients. 2
Management Implications at Stage 3A
At Stage 3A, focus should be on evaluating and treating risk factors for CKD progression, including blood pressure control, glycemic optimization in diabetes, and cardiovascular risk reduction. 1
Systematic screening for CKD complications should begin at this stage, including monitoring for anemia, bone mineral disorders (calcium, phosphate, PTH, vitamin D), metabolic acidosis, and electrolyte abnormalities. 1
Blood pressure target should be <130/80 mmHg, with ACE inhibitor or ARB therapy strongly recommended if albuminuria is present. 1, 3
Monitoring frequency depends on albuminuria status: 2 times per year for moderate risk (UACR <30 mg/g), 3 times per year for high risk (UACR 30-300 mg/g), and 4 times per year with nephrology referral for very high risk (UACR >300 mg/g). 3
Prognosis and Progression Risk
Approximately 48% of Stage 3 CKD patients do not progress over 10 years, while 17.3% progress to Stage 4 and 34.6% progress to Stage 5. 2
In older populations (≥65 years), eGFR 45-59 mL/min/1.73 m² is associated with increased risk of kidney failure (HR 3.048), cardiovascular disease (HR 1.103), and all-cause death (HR 1.172) compared to eGFR 60-89, even without proteinuria. 4
Early diagnosis and intervention at Stage 3A significantly reduces annual eGFR decline from approximately 3.20 mL/min/1.73 m² before diagnosis to 0.74 mL/min/1.73 m² after diagnosis with appropriate management. 5
Common Pitfalls to Avoid
Do not rely on eGFR alone without measuring albuminuria, as this provides incomplete risk stratification and may lead to undertreatment of high-risk patients. 3
Do not assume Stage 3A CKD will inevitably progress to kidney failure, as nearly half of patients remain stable with appropriate management. 2
Delayed diagnosis by even 1 year is associated with 40% increased risk of progression to Stage 4/5 and 63% increased risk of kidney failure, emphasizing the importance of timely recognition and intervention. 5