Glomerular filtration rate: when to measure and in which patients?

Area of Science:

• Nephrology
• Renal Medicine
• Precision Medicine

Background:

• Nephrologists primarily focus on albuminuria and glomerular filtration rate (GFR) for chronic kidney disease (CKD) staging.
• While GFR and albuminuria correlate with morbidity and mortality, the clinical utility of measured GFR (mGFR) is debated.
• Accurate GFR measurement is vital for precise glomerular function assessment and individualized CKD therapy.

Purpose of the Study:

• To highlight clinical scenarios where measured GFR (mGFR) is essential for accurate diagnosis and treatment.
• To emphasize the importance of mGFR in precision medicine for CKD patients.
• To advocate for further research into the benefits of mGFR in specific patient subgroups.

Main Methods:

• Review of clinical situations where estimated GFR (eGFR) may be imprecise.
• Discussion of the impact of accurate GFR on therapeutic interventions and patient outcomes.
• Analysis of the role of mGFR in personalized medicine and risk mitigation.

Main Results:

• mGFR provides the most precise measure of glomerular function, essential for individualizing therapy in CKD.
• In conditions like sarcopenia and advanced cirrhosis, mGFR is particularly important due to eGFR imprecision.
• Standardization of mGFR techniques is improving its clinical applicability.

Conclusions:

• Individualized therapy based on accurate GFR measurement is crucial for optimizing patient quality of life and reducing complications in CKD.
• While population-level benefits of mGFR may not be evident in large databases, its precision is vital for individual patient care.
• Further research is needed to fully understand and implement the clinical utility of mGFR in specific CKD patient subgroups.