Management of eGFR 61 mL/min/1.73 m²
An eGFR of 61 mL/min/1.73 m² represents CKD Stage 2 (mildly decreased kidney function) and requires annual monitoring with minimal medication adjustments at this level. 1
Classification and Current Status
- Your eGFR of 61 mL/min/1.73 m² falls into CKD Stage 2 (60-89 mL/min/1.73 m²), defined as mildly decreased GFR with evidence of kidney damage 2, 1
- This level of kidney function is considered mild renal insufficiency and does not yet meet criteria for moderate impairment (which begins at eGFR <60 mL/min/1.73 m²) 2
Monitoring Requirements
Annual assessments are sufficient at this eGFR level:
- Measure serum creatinine and calculate eGFR once yearly 1
- Obtain urine albumin-to-creatinine ratio (UACR) annually to assess for proteinuria 1
- Check blood pressure at each clinical visit with target <130/80 mmHg 2, 1
Increase monitoring frequency to every 6 months if: 1
- eGFR declines by >5 mL/min/1.73 m² per year
- You have diabetes mellitus
- Evidence of progressive kidney function decline emerges
Medication Management
At eGFR 61 mL/min/1.73 m², most medications require NO dose adjustment: 1
- ACE inhibitors and ARBs can be used at standard doses with appropriate monitoring 2, 1, 3
- Fenofibrate does not require dose reduction (adjustment only needed when eGFR <60 mL/min/1.73 m²) 1
- Metformin can be continued safely at this eGFR level 4
- Most other medications do not require adjustment until eGFR drops below 60 mL/min/1.73 m² 1, 5
Important monitoring for ACE inhibitors/ARBs: 3
- Check serum creatinine and potassium within 7-14 days after starting or dose changes
- Do not discontinue if creatinine increases ≤30% in absence of volume depletion
- Monitor for hyperkalemia development
Prevention of Further Decline
Implement these strategies to slow progression:
- Optimize blood pressure control to <130/80 mmHg, preferably with ACE inhibitors or ARBs if hypertension and albuminuria are present 2, 1
- Achieve glycemic control if diabetic (target HbA1c ~7%) 2, 1
- Avoid nephrotoxic medications including NSAIDs, which can worsen renal function and hypertension 2, 1, 6
- Address cardiovascular risk factors including smoking cessation, weight management if obese, and regular physical activity 1
When to Escalate Care
Consider nephrology referral if: 1
- Rapid eGFR decline (>5 mL/min/1.73 m² per year)
- Significant proteinuria (UACR >300 mg/g)
- Difficult-to-control hypertension despite multiple agents
- Suspected non-diabetic kidney disease
- eGFR declines to <60 mL/min/1.73 m² (entering Stage 3 CKD)
If eGFR drops below 60 mL/min/1.73 m²: 1
- Increase monitoring frequency
- Evaluate for CKD complications (anemia, bone disease, electrolyte abnormalities)
- Begin more intensive medication dose adjustments 2, 5
Critical Pitfalls to Avoid
- Do not assume "normal" creatinine means normal kidney function - elderly patients can have significantly reduced eGFR despite normal serum creatinine due to decreased muscle mass 6
- Avoid NSAIDs as they can precipitate acute kidney injury and worsen hypertension, particularly problematic in elderly patients 2, 6
- Do not combine ACE inhibitors with ARBs - dual RAAS blockade increases risks of hyperkalemia and acute kidney injury without additional benefit 2, 7
- Temporarily hold ACE inhibitors/ARBs during serious intercurrent illness, volume depletion, before major surgery, or with IV contrast administration 3