The control of common cardiovascular risk factors (blood pressure [BP], lipids, diabetes) is key in patients with low eGFR, both to reduce cardiovascular mortality and morbidity, and to slow progression of kidney disease. In patients with low eGFR, it’s important to check urine for albumin or protein. If elevated, then consider an agent that inhibits or blocks the renin-angiotensin system and aim for a target BP of < 130/80 mm Hg.

Serial monitoring is essential at 1-2-month intervals for the initial 3-6 months to assess progression and assure stability. Most elderly patients with low eGFR may not have kidney disease but are at risk for cardiovascular complications, so control of CV risk factors is vital. Patients who have progressive decline in eGFR or have eGFR of < 45 ml/min should be referred to a nephrologist for close monitoring and management.

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