Chronic kidney disease

Prevention of complications from decreased GFR
Threats to patient safety
Chronic kidney disease has been recognised as a 
potential risk factor for medical errors.
63
Furthermore, 
acute kidney injury is a frequent complication of medical 
errors and can potentially accelerate progression to 
kidney failure.
20,21
Decreased GFR is associated with altered 
pharmacokinetics and pharmacodynamics of many 
drugs, leading to an increased risk of toxic eff ects if the 
dose is not appropriately adjusted. Patients with decreased 
GFR are also at an increased risk of complications from 
administration of intravenous fl uid—eg, fl uid overload 
Optimum
High-
normal
Very
high
>105
<10
10–29
30–299
>300
23·6%
5·7%
1·9%
0·1%
31·4%
20·0%
4·7%
1·7%
0·3%
26·7%
17·3%
4·1%
1·6%
0·2%
23·0%
8·2%
2·7%
1·3%
0·1%
12·2%
2·5%
1·1%
0·8%
0·2%
4·7%
0·6%
0·4%
0·4%
0·2%
1·5%
0·1%
0·1%
0·1%
0·1%
0·4%
0·0%
0·0%
0·0%
0·1%
0·1%
72·2%
18·8%
7·8%
1·3%
100·0%
<15
90–104
75–89
60–74
45–59
30–44
15–29
Albuminuria stages, description, and range (mg/g)
A1
A2
A3
High
All
High and
optimum
Mild-moderate
Moderate-severe
Severe
Kidney failure
All
Mild
G1
G2
G3a
G3b
G4
G5
GFR stages, 
description, and range
(mL/min per 1·73m²)
Figure 4: Prevalence of chronic kidney disease in the USA by GFR and albuminuria
Grey shading=CKD defi ned by glomerular fi ltration rate (GFR) or albuminuria (13·8%). Cells show the proportion of 
adult population in the USA. Data from the National Health and Nutrition Examination Survey (NHANES III 
1999–2000, 2001–02, 2003–04, and 2005–06 (N=18 026). GFR is estimated with the CKD-EPI equation and 
standardised serum creatinine. Albuminuria is established by one measurement of albumin-to-creatinine ratio 
(ACR); thus proportions for GFR >60 mL/min per 1·73 m² exceed those reported elsewhere.
29
Values in cells might 
not total to values in margins because of rounding. Category of very high albuminuria includes nephrotic range. 
For eGFRs of 45–59 ml/min per 1·73 m², percentages estimated with the CKD-EPI equation for urine ACR 
categories <10, 10–29, 30–299, and >300 mg/g (2·5%, 1·1%, 0·8%, 0.·2%, and 4·7% [subtotal], respectively) are 
lower than for the same categories in the MDRD study equation (3·6%, 1·4%, 0·9%, 0·2%, and 6·1% [subtotal], 
respectively).

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