Does an eGFR of 71 mL/min/1.73 m² Require Treatment?
An eGFR of 71 mL/min/1.73 m² does not require treatment for kidney disease itself, but it does require cardiovascular risk assessment and management, as this level of kidney function is associated with increased cardiovascular morbidity and mortality. 1
Understanding the Clinical Context
An eGFR of 71 mL/min/1.73 m² places the patient in CKD Stage G2 (mildly decreased kidney function, eGFR 60-89 mL/min/1.73 m²). 2 This is not classified as chronic kidney disease unless accompanied by markers of kidney damage (such as albuminuria, hematuria, or structural abnormalities). 2
Key Clinical Implications
Cardiovascular risk is elevated even at this mildly reduced eGFR level. Patients with eGFR 60-89 mL/min/1.73 m² have higher coronary artery calcium scores, elevated cardiac biomarkers (B-type natriuretic peptide and growth differentiating factor-15), and increased carotid intima-media thickness compared to those with eGFR ≥90 mL/min/1.73 m². 1, 3
Long-term cardiovascular disease risk is significantly increased. Over a median 16-year follow-up, individuals with eGFR 60-69 mL/min/1.73 m² had a 40% higher risk of incident cardiovascular disease (HR 1.40,95% CI 1.02-1.93) compared to those with eGFR ≥90 mL/min/1.73 m². 1
Risk of CKD progression exists but is relatively low at this level. Patients with eGFR 60-69 mL/min/1.73 m² had nearly 3-fold higher risk of progressing to CKD Stage 3 or worse (HR 2.94,95% CI 1.80-4.78). 1
What Actions Are Required
Mandatory Initial Assessment
Check for albuminuria using a spot urine albumin-to-creatinine ratio to determine if true CKD is present. 2 The presence of albuminuria would reclassify this patient as having CKD and change management substantially.
Repeat eGFR measurement in 3 months to confirm chronicity, as CKD requires persistently reduced eGFR for at least 3 months. 2
Screen for diabetes and hypertension if not already diagnosed, as these are the most common causes of CKD and require specific management. 2
Cardiovascular Risk Reduction (Primary Focus)
Blood pressure control is essential:
- Target blood pressure <140/90 mm Hg for all patients with reduced eGFR. 2
- If albuminuria is present, consider ACE inhibitors or ARBs as first-line antihypertensive agents. 4, 2
Lipid management:
- Consider statin therapy based on overall cardiovascular risk assessment, as patients with mildly reduced eGFR have elevated cardiovascular risk comparable to other high-risk groups. 1
Glycemic control if diabetic:
- Target HbA1c ≤7% to prevent CKD progression. 2
Medication Safety Measures
Avoid nephrotoxic medications, particularly NSAIDs, which are frequently overlooked as a cause of kidney function decline. 2
No dose adjustments are needed for most medications at eGFR 71 mL/min/1.73 m², as clinically significant drug accumulation typically occurs only when eGFR falls below 30-45 mL/min/1.73 m². 4
Review all current medications to ensure none are unnecessarily nephrotoxic. 2
What Does NOT Require Treatment
Kidney-specific interventions are not indicated at this eGFR level in the absence of albuminuria or other markers of kidney damage. 2
Dietary protein restriction is not recommended unless eGFR falls below 30 mL/min/1.73 m². 4
Nephrology referral is not indicated at this stage unless there is unexplained rapid decline in kidney function, significant albuminuria, or other concerning features. 2 Referral thresholds are typically eGFR <30 mL/min/1.73 m² or severe albuminuria. 2
Critical Monitoring Strategy
Recheck eGFR and urine albumin-to-creatinine ratio annually if no albuminuria is present and kidney function is stable. 2
More frequent monitoring (every 3-6 months) is warranted if the patient has diabetes, hypertension, or if eGFR shows a declining trend. 2
Patient education is often lacking: Only 65% of patients with confirmed CKD are aware of their diagnosis, and awareness is even lower at mild stages of kidney dysfunction. 5 Inform the patient about their kidney function status and the importance of avoiding nephrotoxins.
Common Pitfalls to Avoid
Do not assume normal kidney function based on "normal" serum creatinine alone. In patients with reduced muscle mass, elderly individuals, or those with multiple comorbidities, serum creatinine may appear normal despite significantly reduced eGFR. 6 This is why eGFR calculation is essential.
Do not overlook the cardiovascular implications. The primary threat to patients with mildly reduced eGFR is cardiovascular disease, not progression to dialysis. 1, 3 Management should prioritize cardiovascular risk reduction.
Do not fail to assess for albuminuria. Without knowing albuminuria status, you cannot definitively diagnose or exclude CKD, and this fundamentally changes management. 2