From the Guidelines
Managing a GFR of 45 at home requires a comprehensive approach to slow kidney disease progression, focusing on blood pressure control, dietary modifications, and lifestyle changes to preserve remaining kidney function. According to the most recent guidelines 1, the key strategies include:
- Blood pressure control with medications like ACE inhibitors (such as lisinopril 10-40 mg daily) or ARBs (such as losartan 50-100 mg daily), targeting blood pressure below 130/80 mmHg
- Dietary modifications, including:
- Limiting sodium to less than 2,300 mg daily
- Moderating protein intake to 0.8 g/kg body weight per day
- Avoiding processed foods
- Staying well-hydrated with about 2 liters of water daily, unless fluid restriction is advised by a doctor
- Regular blood glucose monitoring, aiming for an A1C below 7% if diabetes is present
- Avoiding nephrotoxic drugs like NSAIDs (ibuprofen, naproxen) and certain antibiotics
- Implementing a regular exercise routine of 150 minutes weekly of moderate activity, such as walking or swimming
- Tracking weight, blood pressure, and symptoms like increased swelling, shortness of breath, or changes in urination
These strategies are crucial in reducing filtration pressure, minimizing inflammation, and preventing further damage to nephrons, which is essential for managing moderate kidney disease (Stage 3B) and preventing progression 1. Additionally, referral to a nephrologist may be necessary for consultation and co-management, especially if the patient's personal physician cannot adequately evaluate and treat the patient 1.
From the FDA Drug Label
Impaired renal function decreases elimination of lisinopril, which is excreted principally through the kidneys, but this decrease becomes clinically important only when the glomerular filtration rate is below 30 mL/min. Above this glomerular filtration rate, the elimination half-life is little changed No dose adjustment of lisinopril is required in patients with creatinine clearance > 30 mL/min
For a patient with a GFR of 45, which is above 30 mL/min, no dose adjustment of lisinopril is required.
- The patient can continue taking lisinopril as prescribed.
- However, it is essential to monitor renal function and adjust the dose if the GFR falls below 30 mL/min.
- Regular follow-up with a healthcare provider is necessary to assess the patient's condition and adjust the treatment plan as needed 2, 2.
From the Research
Management of GFR 45 at Home
To manage a Glomerular Filtration Rate (GFR) of 45 at home, several strategies can be employed:
- Cardiovascular Risk Reduction: This includes the use of statins and management of blood pressure to reduce the risk of cardiovascular disease, a common complication in patients with chronic kidney disease (CKD) 3.
- Treatment of Albuminuria: Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers can be used to treat albuminuria, which is a sign of kidney damage 3, 4.
- Avoidance of Nephrotoxins: Patients with CKD should avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) and other potential nephrotoxins to prevent further kidney damage 3.
- Adjustments to Drug Dosing: The dosing of certain drugs, such as antibiotics and oral hypoglycemic agents, may need to be adjusted in patients with CKD to prevent toxicity 3.
- Monitoring for Complications: Patients with CKD should be monitored regularly for complications such as hyperkalemia, metabolic acidosis, hyperphosphatemia, vitamin D deficiency, secondary hyperparathyroidism, and anemia 3.
Lifestyle Modifications
In addition to medical management, lifestyle modifications can also play a crucial role in managing CKD:
- Dietary Changes: A healthy diet that is low in protein, salt, and phosphorus can help to slow the progression of CKD 3.
- Regular Exercise: Regular exercise can help to reduce blood pressure and improve overall health in patients with CKD 3.
- Stress Management: Stress management techniques, such as meditation and yoga, can help to reduce stress and improve overall well-being in patients with CKD 3.
Importance of Regular Monitoring
Regular monitoring of kidney function and other health parameters is crucial in managing CKD:
- GFR Monitoring: Regular monitoring of GFR can help to track the progression of CKD and adjust treatment accordingly 5, 6.
- Albuminuria Monitoring: Regular monitoring of albuminuria can help to track kidney damage and adjust treatment accordingly 3, 4.
- Blood Pressure Monitoring: Regular monitoring of blood pressure can help to track cardiovascular risk and adjust treatment accordingly 3, 7.