Estimated GFR (eGFR)
eGFR estimates kidney filtering from blood creatinine, age and sex. KDIGO defines decreased GFR as below 60 and grades it G3a to G5. Lower eGFR goes with more deaths, kidney failure and heart disease in pooled cohorts. More muscle, creatine supplements and a cooked meat meal each raise creatinine, which lowers the estimate whether or not filtering has changed.
Checked 2026-11-13
- Status
- Serum creatinine is part of routine metabolic blood panels, and US laboratories report an eGFR calculated from it. FDA classifies creatinine test systems as class II devices [1]. In 2021 a task force of the National Kidney Foundation and the American Society of Nephrology advised all US laboratories to adopt the 2021 CKD-EPI creatinine equation, which uses creatinine, age and sex and has no race term [2].
- Measures
- An estimate of the volume of blood the kidneys filter each minute, scaled to a body surface area of 1.73 m2. It is calculated from serum creatinine, a substance tied to muscle mass, together with age and sex [2][3].
- Also called
- eGFR, estimated GFR, estimated glomerular filtration rate, GFR, glomerular filtration rate, eGFRcr, eGFR CKD-EPI, CKD-EPI 2021, kidney function test
- Tested for
- kidney function, kidney disease screening, chronic kidney disease staging, medication dosing, diabetes and blood pressure checkups, kidney check while taking creatine
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Linked in research4
- StrongLinked to more deaths at lower eGFR: against 95, risk was 18% higher at 60, 57% higher at 45 and about 3 times higher at 15.
- StrongLinked to far more kidney failure at lower eGFR: against 95, the hazard was 4 times higher at 60, 29 times at 45 and 454 times at 15.
- ModerateLinked to more coronary heart disease, stroke, heart failure, atrial fibrillation and hospital admissions at lower eGFR in an analysis of 114 cohorts.
- ModerateShown in trials: across 47 trials of 12 interventions, treatments that slowed the yearly fall in GFR also reduced kidney failure and doubling of creatinine.
Reported risks0
No risks sourced yet.
Reference ranges
Each range is the one its source published, in mL/min/1.73 m2. Where sources differ, each is shown.
Kidney Disease: Improving Global Outcomes (KDIGO) guideline, 2024
People being evaluated for chronic kidney disease, as GFR categories · [3]
| Range | What the source calls it |
|---|---|
| below 15 mL/min/1.73 m2 | "G5 Kidney failure" A doctor, immediately |
| 15 to 29 mL/min/1.73 m2 | "G4 Severely decreased" A doctor, immediately |
| 30 to 44 mL/min/1.73 m2 | "G3b Moderately to severely decreased" One to see a doctor about |
| 45 to 59 mL/min/1.73 m2 | "G3a Mildly to moderately decreased" |
| 60 to 89 mL/min/1.73 m2 | "G2 Mildly decreased" |
| 90 or above mL/min/1.73 m2 | "G1 Normal or high" |
KDIGO lists decreased GFR, below 60 mL/min/1.73 m2 (categories G3a to G5), as a criterion for chronic kidney disease only when present for a minimum of 3 months. It states that the term for G2 is relative to the young adult level and that, in the absence of evidence of kidney damage, neither G1 nor G2 fulfills the criteria for chronic kidney disease. That is why G2 is shown here as in range. The classification also uses the cause of disease and the urine albumin category, so a GFR category alone does not give the full KDIGO classification. KDIGO judged the existing staging appropriate for both younger and older adults [3].
National Institute of Diabetes and Digestive and Kidney Diseases, US National Institutes of Health
Adults reading a GFR result, as described on the institute's page for the public · [4]
| Range | What the source calls it |
|---|---|
| 15 or below mL/min/1.73 m2 | "kidney failure" A doctor, immediately |
| 16 to 59 mL/min/1.73 m2 | "may mean you have kidney disease" |
| 60 or above mL/min/1.73 m2 | "normal range" |
The page states that a GFR of 60 or more is in the normal range, that a GFR of less than 60 may mean kidney disease, and that a GFR of 15 or less is called kidney failure. It prints no number between 15 and 60 for where the middle band starts, and this block starts it at 16. KDIGO draws its lowest line at below 15, so a result of exactly 15 falls in different bands in the two sources. Page last reviewed October 2016 [4].
Delanaye and colleagues, proposed age-adapted definition, 2019, adults under 40
Adults younger than 40 with no other evidence of kidney damage · [5]
| Range | What the source calls it |
|---|---|
| below 75 mL/min/1.73 m2 | "CKD" |
| 75 or above mL/min/1.73 m2 | No name given |
A proposal from a group of kidney researchers, not an adopted guideline. They argue that GFR declines with age in people without kidney disease and that the level below which mortality rises differs by age: below 75 mL/min/1.73 m2 in younger people and below 45 in older people. The proposal applies only to people without other evidence of kidney damage, notably those with normal urine albumin. KDIGO's 2024 guideline describes this proposal and keeps one threshold of 60 for all adults [3][5].
Delanaye and colleagues, proposed age-adapted definition, 2019, adults 40 to 65
Adults aged 40 to 65 with no other evidence of kidney damage · [5]
| Range | What the source calls it |
|---|---|
| below 60 mL/min/1.73 m2 | "CKD" |
| 60 or above mL/min/1.73 m2 | No name given |
The same threshold as the current definition of chronic kidney disease, kept for this age group in the proposal [5].
Delanaye and colleagues, proposed age-adapted definition, 2019, adults over 65
Adults older than 65 with no other evidence of kidney damage · [5]
| Range | What the source calls it |
|---|---|
| below 45 mL/min/1.73 m2 | "CKD" |
| 45 or above mL/min/1.73 m2 | No name given |
Under the proposal, a person older than 65 in KDIGO category G3a with normal urine albumin would not be counted as having chronic kidney disease. KDIGO does count that person [3][5].
What has been shown to move it
Shown to lower it5
Raised serum creatinine and kidney markers
Shown to raise blood creatinine, which lowers kidney estimates based on it. Kidney function measured another way did not change.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- In 26 RCTs (1,036 participants), serum creatinine rose 0.14 mg/dL (95% CI 0.05 to 0.22, I² 93.9%) and creatinine-based GFR estimates fell 10.75 mL/min (95% CI -17.48 to -4.02). GFR measured with Cr-EDTA, which does not rely on creatinine, did not differ (5.89 mL/min, 95% CI -0.30 to 12.08), nor did urea, albuminuria or proteinuria [18]. In 20 randomized trials, serum creatinine rose 0.13 mg/dL (95% CI 0.07 to 0.18), and urea and eGFR did not differ (eGFR -5.20 mL/min/1.73 m², 95% CI -15.00 to 4.60) [19]. In 12 studies (440 participants), serum creatinine rose by a mean of 0.07 (95% CI 0.01 to 0.12), significant at 1 week or less and after 12 weeks but not at 1 to 12 weeks. Glomerular filtration rate did not differ from control [20].
- Population
- Healthy people and people with chronic kidney disease, including a hemodialysis subgroup [18]; 19 RCTs and one crossover trial [19]; mostly healthy adults, 177 on creatine and 263 controls in the creatinine analysis [20].
- Sources
- [18], [19], [20]
- Caveats
- Creatinine is a breakdown product of creatine, so a higher reading and a lower creatinine-based GFR estimate can occur without a change in filtration. The authors of [18] attribute the changes to altered creatinine metabolism, since Cr-EDTA GFR did not change. The 2025 abstract reports its creatinine difference in µmol/L, a unit at which 0.07 would be negligible, and the unit may be a reporting error [20]. The authors of [19] call for trials longer than 1 year.
Early drop in kidney filtration and acute kidney injury
Mixed results: the labels report a small drop in eGFR in the first weeks and kidney injury reports after marketing, while pooled trials found 23% fewer acute kidney injuries.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- The empagliflozin label states that starting treatment raises serum creatinine and lowers eGFR within weeks, then stabilizes. In its cardiovascular trial the change generally did not exceed 0.1 mg/dL and 9.0 mL/min/1.73 m² at week 4, and reversed after stopping. Acute kidney injury is listed among postmarketing reports [20]. Across 13 placebo-controlled trials, allocation to an SGLT2 inhibitor lowered the risk of acute kidney injury by 23% (RR 0.77, 95% CI 0.70 to 0.84) [4]. In the dapagliflozin heart failure trial, kidney adverse events did not differ from placebo [2].
- Population
- Adults in empagliflozin trials [20]; 90,409 participants in 13 trials [4]; 4,744 adults with heart failure [2].
- Sources
- [20], [4], [2]
- Caveats
- The label gives no share of people for the early eGFR drop. Postmarketing reports have no denominator.
Faster kidney decline and more vascular events in diabetic kidney disease
One trial found kidney filtration fell faster on B vitamins than placebo in 238 people with diabetic nephropathy, and vascular events or death were twice as common.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- At 36 months, kidney filtration fell 16.5 mL/min/1.73 m² on B vitamins and 10.7 on placebo (difference -5.8, 95% CI -10.6 to -1.1). Heart attack, stroke, revascularization or death was twice as common (HR 2.0, 95% CI 1.0 to 4.0) [6].
- Population
- 238 people with type 1 or 2 diabetes and diabetic nephropathy at 5 Canadian centers [6].
- Sources
- [6]
- Caveats
- One trial. Dialysis need did not differ (HR 1.1) [6].
Kidney markers
One small trial found estimated GFR fell 13.3% on high-dose glutamine against 2.9% on control over 14 days in older adults.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- In a crossover RCT of 30 adults (mean age 69) given 0.5 g per kg a day for 14 days, estimated GFR fell 13.3% on glutamine against 2.9% on a casein control, with small rises in urea nitrogen and creatinine; no adverse clinical effects were seen [7]. A review of kidney safety in athletes found 5 glutamine studies; short-term (20 to 30 g within a few hours) and 2-week (0.1 g per kg four times a day) use showed no significant adverse effects in healthy athletes, while the review notes glomerulosclerosis and raised creatinine reported in the setting of diabetic kidney disease [8].
- Population
- Older care-home residents [7]; athletes and bodybuilders [8].
- Sources
- [7], [8]
- Caveats
- The authors of [7] describe the eGFR drop as below their 25% threshold for biological significance. Reference [8] is a narrative review of few studies.
Faster kidney decline in diabetic nephropathy
One trial found faster kidney decline and more heart events on high-dose B vitamins in people with diabetic kidney disease. The tablet combined folic acid and B6.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- At 36 months, filtration rate fell 16.5 mL/min/1.73 m² on high-dose B vitamins and 10.7 on placebo, a difference of -5.8 (95% CI -10.6 to -1.1). A composite of heart attack, stroke, revascularization and death occurred more often on B vitamins (HR 2.0, 95% CI 1.0 to 4.0). Dialysis did not differ [13].
- Population
- 238 people with type 1 or 2 diabetes and diabetic nephropathy, mean follow-up 31.9 months [13].
- Sources
- [13]
- Caveats
- One trial of a combined tablet with folic acid and B6, so the effect cannot be assigned to B12 alone.
Shown to raise it1
Kidney function in people without kidney disease
Shown to raise kidney filtration rate, urea and urine calcium in people without kidney disease, with no consistent sign of kidney injury in mostly short trials.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- Across 30 studies (2,160 people), GFR rose 7.18 mL/min/1.73 m² more on high-protein diets (95% CI 4.45 to 9.91), with higher serum urea (1.75 mmol/L), urinary calcium (25.43 mg a day) and serum uric acid [11]. In 22 RCTs, eGFR rose (SMD 0.39, 95% CI 0.09 to 0.69, I² 74.9%) and serum creatinine did not change (SMD 0.08, 95% CI -0.09 to 0.25) [5]. In 28 trials (1,358 people), GFR after the diet was slightly higher (SMD 0.19, 95% CI 0.07 to 0.31), and the change in GFR did not differ (SMD 0.11, 95% CI -0.05 to 0.27) [9].
- Population
- Adults without chronic kidney disease in randomized trials [5][9][11].
- Sources
- [5], [9], [11]
- Caveats
- Most trials were short and used creatinine-based estimates, so long-term effects are uncertain [5]. Cohorts disagree: in 9,226 Korean adults, the highest protein quarter was linked to 1.32 times the risk of rapid eGFR decline (95% CI 1.02 to 1.73) [12], while a meta-analysis of 6 cohorts (148,051 people) linked higher protein to lower chronic kidney disease incidence (RR 0.82, 95% CI 0.71 to 0.94) [13].
Tested, and not shown to change it2
Slowing chronic kidney disease
Not shown to slow loss of kidney function in two placebo-controlled trials, in chronic kidney disease and in type 1 diabetes.
The numbers and sources
- Effect
- In adults with stage 3 or 4 chronic kidney disease, eGFR fell 3.33 mL/min/1.73 m² a year on allopurinol and 3.23 on placebo (difference -0.10, 95% CI -1.18 to 0.97) [9]. In people with type 1 diabetes and early kidney disease, serum urate fell from 6.1 to 3.9 mg/dL on allopurinol and stayed at 6.1 on placebo. Measured GFR after 3 years and a washout did not differ (difference 0.001, 95% CI -1.9 to 1.9), and urinary albumin excretion was 40% higher on allopurinol (95% CI 0 to 80) [10].
- Population
- 363 adults with chronic kidney disease, no gout and a mean eGFR of 31.7, followed 104 weeks [9]; 530 people with type 1 diabetes and a GFR of 40 to 99.9 [10].
- Sources
- [9], [10]
- Caveats
- The first trial stopped recruiting early, at 369 of a planned 620 people [9].
Kidney function in people with kidney disease
Mixed results: two trials including people with early kidney disease found no harm to kidney function, while a cohort linked more protein to faster decline in women with mild impairment.
In a 2-year trial, eGFR rose similarly on low-carbohydrate (protein 22% of energy), Mediterranean and low-fat diets, and rose 7.1% in people starting with eGFR under 60.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- In type 2 diabetes with early kidney disease, 12 months on a moderate-protein against a standard-protein weight-loss diet did not change isotope-measured GFR, eGFR, cystatin C or albuminuria. Weight loss improved kidney function on both [10]. In a 2-year trial, eGFR rose similarly on low-carbohydrate (protein 22% of energy), Mediterranean and low-fat diets, and rose 7.1% in people starting with eGFR under 60 [14]. Over 11 years, each 10 g a day more protein was linked to an eGFR change of -1.69 mL/min/1.73 m² (95% CI -2.93 to -0.45) in women with mild renal insufficiency, and to no change in women with normal function [15].
- Population
- 76 adults with type 2 diabetes and an albumin to creatinine ratio of 3 to 30 mg/mmol, 45 completing [10]; 318 adults with eGFR of 30 or more, 86% men [14]; 1,624 women aged 42 to 68 in the Nurses' Health Study, observational [15].
- Sources
- [10], [14], [15]
- Caveats
- The trials were small or not designed around kidney disease, and the protein difference was modest, 19 g a day in [10]. The cohort used food questionnaires, and the link was strongest for nondairy animal protein [15].
How it compares with the reference method
Matched the reference method1
The 2021 CKD-EPI creatinine equation against measured GFR
Shown to fall within 30% of measured GFR in 85% or more of people, reading a median 3.6 lower in Black and 3.9 higher in non-Black participants.
The numbers and sources
- Compared with
- GFR measured by clearance of an injected filtration marker
- Effect
- The 2021 equation, built from age, sex and creatinine with no race term, was tested in 12 studies. It underestimated measured GFR in Black participants by a median of 3.6 mL/min/1.73 m2 (95% CI 1.8 to 5.5) and overestimated it in non-Black participants by 3.9 (3.4 to 4.4). The earlier equation with a race term overestimated by 3.7 in Black participants and 0.5 in non-Black participants. For all equations, 85% or more of estimates were within 30% of measured GFR, and equations that add cystatin C were more accurate, with over 90% within 30% [10]. KDIGO treats 80% within 30% as acceptable and 90% as its higher target, and notes that at a true GFR of 60, a 30% error spans 42 to 78 mL/min/1.73 m2 [3].
- Population
- 4,050 participants in 12 validation studies, 14.3% Black. The equations were developed in 8,254 participants from 10 studies [10].
- Sources
- [10], [3]
- Caveats
- Compared with the earlier equation, the 2021 equation raised estimates of chronic kidney disease prevalence among Black adults and gave similar or lower prevalence among non-Black adults, so results from before and after a laboratory changed equations differ [10]. KDIGO reports very low accuracy for all estimating equations in people who are frail or severely ill [3].
Mixed results1
Variation from one test to the next
Shown to vary about 5% within a person between tests. KDIGO treats a change of more than 20% as beyond expected variability.
The numbers and sources
- Compared with
- Repeat measurements in the same person
- Effect
- KDIGO reports within-person biological variation of 5.3% (95% CI 4.5 to 6.4) for creatinine-based eGFR, and reference change values of 14% to 20% in people with chronic kidney disease, meaning a change smaller than that can arise from normal biological and analytical variation. Its practice point is that a change in eGFR of more than 20% on a later test exceeds the expected variability [3]. In 91 healthy Europeans sampled weekly for 10 weeks, within-person variation of serum creatinine was 4.4% (95% CI 4.2 to 4.7) with an enzymatic assay and 4.7% with an alkaline picrate assay. Analytical variation was 1.1% for the enzymatic method and 4.4% for the alkaline picrate method, which failed the imprecision specification the authors derived [18].
- Population
- 91 healthy adults aged 21 to 69 at 6 European laboratories [18]. KDIGO draws its figures from earlier studies of people with and without chronic kidney disease [3].
- Sources
- [3], [18]
- Caveats
- The KDIGO figures are quoted from the guideline, not from the primary studies. A laboratory report does not always say which creatinine method was used.
Did not match the reference method4
Muscle mass
One study of 170 healthy adults found serum creatinine rose with lean mass while cystatin C, another filtration marker, did not.
The numbers and sources
- Compared with
- Serum cystatin C measured in the same people
- Effect
- In 170 healthy adults, serum creatinine correlated with body weight and more strongly with lean mass, and cystatin C correlated with neither. People with moderate or intense physical activity had more lean mass (55.3% against 48.5%) and higher serum creatinine (1.04 against 0.95 mg/dL) than sedentary people, with no difference in cystatin C. Lean mass stayed related to creatinine after adjustment for protein and meat intake and physical activity [11]. KDIGO lists body builders, extreme sport, eating disorders, above-knee amputation and spinal cord injury as settings where creatinine-based eGFR loses accuracy and a cystatin C-based estimate may be appropriate [3]. Laboratories print serum creatinine intervals by sex: 0.67 to 1.17 mg/dL for men and 0.51 to 0.95 for women in a US national survey laboratory manual, and 0.70 to 1.30 and 0.50 to 1.10 in an internal medicine board table [12][13].
- Population
- 92 women and 78 men, healthy, grouped as sedentary, mildly active or moderately to intensely active [11].
- Sources
- [11], [3], [12], [13]
- Caveats
- The study did not measure GFR directly, so it shows that creatinine tracks muscle, not by how much any one eGFR is off [11]. Serum creatinine in mg/dL is a different quantity from eGFR, so its intervals are described here and not placed as ranges on this page.
Creatine supplements
Shown to raise serum creatinine about 0.13 mg/dL in pooled trials. Creatinine-based GFR estimates fell in one analysis while GFR measured with a tracer did not.
The numbers and sources
- Compared with
- GFR measured with Cr-EDTA, a tracer method that does not rely on creatinine
- Effect
- In 26 randomized trials, creatine supplementation raised serum creatinine by 0.14 mg/dL (95% CI 0.05 to 0.22) and lowered GFR assessed by creatinine-based methods by 10.75 mL/min (95% CI -17.48 to -4.02). GFR assessed by Cr-EDTA did not differ significantly (5.89 mL/min, 95% CI -0.30 to 12.08), nor did serum urea, albuminuria or proteinuria [14]. A second meta-analysis of 20 randomized studies found serum creatinine 0.13 mg/dL higher (95% CI 0.07 to 0.18) and no significant difference in eGFR (-5.20 mL/min/1.73 m2, 95% CI -15.00 to 4.60) [15].
- Population
- 1,036 participants in 26 trials, healthy people and people with chronic kidney disease [14]. 19 randomized trials and one randomized crossover study [15].
- Sources
- [14], [15]
- Caveats
- The authors of the first analysis attribute the changes to altered creatinine metabolism, not kidney injury, because the tracer measurement did not change [14]. The two analyses disagree on whether the fall in estimated GFR is statistically significant. The authors of the second call for trials longer than 1 year [15].
A cooked meat meal before the blood draw
Shown to raise serum creatinine and lower eGFR for hours after a cooked meat meal, from a median of 84 to 59.5 in one study.
The numbers and sources
- Compared with
- The same people's results before the meal and after a meat-free meal
- Effect
- In 32 people, median serum creatinine rose from 80.5 µmol/L before a cooked meat meal to 101.0 µmol/L 1 to 2 hours after and 99.0 µmol/L at 3 to 4 hours. Median eGFR fell from 84.0 to 59.5 and 64.0 mL/min/1.73 m2. Meat-free meals had little effect, and cystatin C was generally unaffected by food [16]. In 80 people, a standardized cooked meat meal with about 54 g of protein raised serum creatinine and lowered eGFR at every stage of diabetes-related kidney disease studied. Six of 16 people in stage 3a were reclassified as stage 3b, and the effect was gone after a 12-hour fast [17]. KDIGO describes a rise of about 20 µmol/L (0.23 mg/dL) in one study and states that waiting at least 12 hours after eating meat or fish avoids the effect [3].
- Population
- 17 healthy volunteers and 15 outpatients [16]. 80 people: healthy volunteers and people with diabetes at 4 stages of chronic kidney disease, 16 per group [17].
- Sources
- [16], [17], [3]
- Caveats
- Both studies are small, and each used an older estimating equation than the 2021 CKD-EPI equation. The second gives no size for the fall in its abstract [17].
Creatinine-based eGFR against cystatin C-based eGFR
Shown to place fewer people below 60 than cystatin C-based eGFR, 9.7% against 13.7%, and to track death and kidney failure less closely.
The numbers and sources
- Compared with
- eGFR calculated from cystatin C, alone or combined with creatinine
- Effect
- In 11 general population studies, 13.7% of people had an eGFR below 60 mL/min/1.73 m2 by cystatin C against 9.7% by creatinine. People moved to a higher eGFR category by cystatin C had lower risk of death, cardiovascular death and end-stage renal disease, and people moved to a lower category had higher risk. The net reclassification improvement with cystatin C was 0.23 (95% CI 0.18 to 0.28) for death and 0.10 (0.00 to 0.21) for end-stage renal disease [19]. Equations that combine creatinine and cystatin C were closer to measured GFR than creatinine-only equations in a separate study [10].
- Population
- 90,750 participants in 11 general population studies and 2,960 in 5 cohorts with chronic kidney disease [19].
- Sources
- [19], [10]
- Caveats
- Cystatin C has its own non-kidney influences. KDIGO names steroid use, thyroid disease and cancer [3]. The study was funded in part by the National Kidney Foundation [19].
What studies tie it to
Linked in research4
Death from any cause and from cardiovascular disease
Linked to more deaths at lower eGFR: against 95, risk was 18% higher at 60, 57% higher at 45 and about 3 times higher at 15.
The numbers and sources
- Effect
- In a collaborative meta-analysis of general population cohorts, risk of death was unrelated to eGFR between 75 and 105 mL/min/1.73 m2 and rose at lower values. Against an eGFR of 95, adjusted hazard ratios for death from any cause were 1.18 (95% CI 1.05 to 1.32) at 60, 1.57 (1.39 to 1.78) at 45 and 3.14 (2.39 to 4.13) at 15, with similar findings for cardiovascular death [6]. In a later individual-participant analysis of 114 cohorts, lower eGFR was significantly associated with higher all-cause and cardiovascular mortality, including in the mildest categories of chronic kidney disease [7].
- Population
- 105,872 participants in 14 studies with urine albumin-to-creatinine measurements and 1,128,310 in 7 studies with dipstick measurements [6]. 27,503,140 individuals in 114 cohorts, mean age 54, mean follow-up 4.8 years [7].
- Sources
- [6], [7]
- Caveats
- Observational. Urine albumin predicted death independently of eGFR, so eGFR alone gives part of the picture [6]. KDIGO notes that creatinine-based eGFR has a J-shaped association with most outcomes, with risk also rising above 105 mL/min/1.73 m2, and that very low creatinine often reflects frailty or low muscle mass [3].
Kidney failure
Linked to far more kidney failure at lower eGFR: against 95, the hazard was 4 times higher at 60, 29 times at 45 and 454 times at 15.
The numbers and sources
- Effect
- In general population cohorts, risk of end-stage renal disease was unrelated to eGFR between 75 and 105 mL/min/1.73 m2 and rose exponentially below that. Against an eGFR of 95, hazard ratios were 4 at an eGFR averaging 60, 29 at 45 and 454 at 15, after adjustment for albuminuria and cardiovascular risk factors. Similar associations were found for acute kidney injury and progressive chronic kidney disease [8]. A later analysis of 114 cohorts found lower eGFR associated with higher risk of kidney failure requiring replacement therapy and of acute kidney injury [7].
- Population
- 845,125 participants in 9 general population cohorts and 173,892 patients in 8 cohorts at high risk of chronic kidney disease [8]. 27,503,140 individuals in 114 cohorts [7].
- Sources
- [8], [7]
- Caveats
- Observational. These are relative hazards, and the abstract gives no absolute rates. Urine albumin predicted kidney failure independently of eGFR [8].
Heart disease, stroke, heart failure and hospital admission
Linked to more coronary heart disease, stroke, heart failure, atrial fibrillation and hospital admissions at lower eGFR in an analysis of 114 cohorts.
The numbers and sources
- Effect
- In an individual-participant meta-analysis, lower eGFR was significantly associated with higher risk of each of 10 outcomes studied, among them coronary heart disease, stroke, heart failure, atrial fibrillation, peripheral artery disease and any hospitalization. Among people with a urine albumin-to-creatinine ratio below 10 mg/g, an eGFR of 45 to 59 against 90 to 104 mL/min/1.73 m2 went with more hospitalizations (adjusted HR 1.3, 95% CI 1.2 to 1.3), 161 against 79 events per 1,000 person-years [7].
- Population
- 27,503,140 individuals from 114 global cohorts with creatinine-based eGFR, and 720,736 from 20 cohorts with eGFR based on creatinine and cystatin C, from 1980 to 2021 [7].
- Sources
- [7]
- Caveats
- Observational and retrospective. The analysis used the 2021 CKD-EPI equations. Confounding by age and other illness may remain after adjustment [7].
Kidney outcomes in trials of treatments that slowed eGFR decline
Shown in trials: across 47 trials of 12 interventions, treatments that slowed the yearly fall in GFR also reduced kidney failure and doubling of creatinine.
The numbers and sources
- Effect
- In a meta-analysis of 47 randomized trials, a treatment's effect on the 3-year slope of GFR predicted its effect on the clinical endpoint of doubling of serum creatinine, GFR below 15 mL/min/1.73 m2 or end-stage kidney disease (median R squared 0.97, 95% Bayesian credible interval 0.78 to 1.00). A treatment effect of 0.75 mL/min/1.73 m2 per year or greater on slope predicted a clinical benefit with at least 96% probability, given a large enough trial [9].
- Population
- 60,620 participants in 47 randomized trials testing 12 interventions, in people with chronic kidney disease [9].
- Sources
- [9]
- Caveats
- The trials enrolled people with kidney disease and tested drugs and other treatments, so the finding does not describe people with eGFR in the reference range. It concerns the rate of change over years, not one result [9].
Related
Sources
- US Food and Drug Administration. 21 CFR 862.1225, Creatinine test system. Electronic Code of Federal Regulations. https://www.ecfr.gov/current/title-21/section-862.1225
- Delgado C, Baweja M, Crews DC, et al. A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. Journal of the American Society of Nephrology. 2021. https://doi.org/10.1681/ASN.2021070988
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International. 2024. https://doi.org/10.1016/j.kint.2023.10.018
- National Institute of Diabetes and Digestive and Kidney Diseases. Chronic Kidney Disease Tests and Diagnosis. US National Institutes of Health. Last reviewed October 2016. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis
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