From the Guidelines
A GFR of 65 mL/min/1.73m² indicates mild kidney disease, specifically Stage 2 chronic kidney disease (CKD), according to the most recent and highest quality study 1.
Key Points
- This level suggests your kidneys are functioning at about 65% of normal capacity.
- While this represents a decrease from normal kidney function (which is above 90), it doesn't typically require immediate medical intervention beyond careful monitoring and addressing underlying causes.
- You should work with your healthcare provider to identify and manage conditions that might be affecting your kidney function, such as diabetes, high blood pressure, or certain medications.
- Lifestyle modifications are important at this stage, including:
- Maintaining a healthy diet (possibly with reduced sodium, phosphorus, and protein)
- Staying well-hydrated
- Exercising regularly
- Avoiding nephrotoxic medications like NSAIDs
- Quitting smoking if applicable
- Regular monitoring of your kidney function through blood and urine tests is essential to track any progression, as suggested by the Canadian Society of Nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management 1.
Considerations
- The GFR calculation estimates how well your kidneys filter waste from your blood, and this level indicates your kidneys are experiencing some damage but still functioning adequately for most bodily needs.
- The National Kidney Foundation practice guidelines for chronic kidney disease emphasize the importance of using GFR to classify the stage of severity of chronic kidney disease 1.
- It is essential to note that the risk of progression and complications varies depending on the individual's overall health status, presence of comorbidities, and other factors, as highlighted in the study by the National Kidney Foundation 1.
From the FDA Drug Label
Metformin hydrochloride tablets are contraindicated in patients with an eGFR less than 30 mL/min/1.73 m 2 Initiation of metformin hydrochloride tablets is not recommended in patients with eGFR between 30 to 45 mL/min/1. 73 m 2. Obtain an eGFR at least annually in all patients taking metformin hydrochloride tablets. In patients taking metformin hydrochloride tablets whose eGFR falls below 45 mL/min/1. 73 m 2, assess the benefit and risk of continuing therapy.
A GFR of 65 indicates that the patient's renal function is within normal limits for the use of metformin hydrochloride tablets, and no dose adjustment is necessary based on the information provided in the drug label 2. The patient can continue taking metformin hydrochloride tablets as prescribed, with regular monitoring of renal function as recommended.
From the Research
Glomerular Filtration Rate (GFR) of 65
A GFR of 65 indicates a reduced kidney function, which is classified as stage G3b chronic kidney disease (CKD) according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.
- The GFR is a key indicator of kidney function, and a value of 65 is considered to be below the normal range (90-120 ml/min/1.73m²) 3.
- Patients with a GFR of 65 may be at increased risk of developing end-stage renal disease (ESRD) and may require closer monitoring and management of their kidney health 4.
- The use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) may be beneficial in slowing the progression of CKD in patients with a GFR of 65, particularly those with proteinuria or diabetes 5, 6.
- However, the decision to use ACEIs or ARBs should be individualized and based on the patient's specific clinical characteristics and medical history 7.