To assess kidney function and diagnose, stage, and monitor chronic kidney disease (CKD)
With a blood creatinine test as part of a routine health exam or when your healthcare practitioner thinks that you may have kidney damage or that you may be at risk for developing kidney disease; if you are diagnosed with CKD, testing is recommended at least once a year.
A blood sample drawn from a vein; the eGFR is a calculated estimate of the actual glomerular filtration rate and is based on your blood creatinine level and/or blood cystatin C level. Depending on the formula used, your age, sex, and race may also be needed.
This test typically uses a blood creatinine level to calculate a result. You may be instructed to fast overnight or refrain from eating cooked meat; some studies have shown that eating cooked meat prior to testing can temporarily increase the level of creatinine.
If your healthcare practitioner requests a cystatin C test to calculate eGFR, no preparation is required.
Glomerular filtration rate (GFR) is a measure of how well your kidneys are working. The kidney's primary function is to filter blood. Waste and excess water gets removed and turned into urine. The levels of salts and minerals in blood are adjusted to maintain a healthy balance. In addition, kidneys produce hormones that regulate blood pressure, maintain bone health, and control production of red blood cells.
Glomeruli are tiny filters in the kidneys that allow waste products to be removed from the blood, while preventing the loss of important substances, including proteins and blood cells. Every day, healthy kidneys filter about 200 quarts of blood and produce about 2 quarts of urine. The GFR refers to the amount of blood that is filtered by the glomeruli per minute. As kidney function declines due to damage or disease, the filtration rate decreases and waste products begin to build up in the blood.
Chronic kidney disease (CKD) is a common disease associated with a slow and progressive decrease in kidney function. Diabetes and high blood pressure are the two main causes of CKD. Aging is another risk factor for CKD that is often overlooked. As we age, so do our kidneys, losing about 1% of kidney filtration per year after age of 40.
Kidney diseases tend to progress silently and most cases of early stages of CKD go undiagnosed. Most people have no symptoms until 30-40% of kidney function is lost. Early detection of kidney dysfunction is crucial because it can help to minimize the damage by starting a suitable treatment. Screening for CKD is recommended for high risk groups, such as people with diabetes, high blood pressure (hypertension), heart disease, family history of kidney failure, and the elderly (age 60 and older).
Measuring glomerular filtration rate (GFR) directly is considered the most accurate way to detect changes in kidney function, but measuring the GFR directly is complicated, requires experienced personnel, and is typically performed only in research settings and transplant centers. For this reason, the estimated GFR (eGFR), which represents the best routinely available measurement of kidney function, is usually used. See "How can my actual GFR be determined?" under Common Questions for more information.
The eGFR is calculated according to the formulae recommended by the National Kidney Foundation using measured test results of blood creatinine levels and in special circumstances blood cystatin C levels.
Different equations may be used to calculate eGFR. The following two are most common and require a blood creatinine result, age, and assigned values based upon sex and race.
Additional sets of CKD-EPI equations recommended by the National Kidney Foundation for adults that use cystatin C level to calculate eGFR, along with age and gender, include:
The results reported using one of the above equations versus the other will not be identical but should give a healthcare practitioner similar information.
Separate equations, based on serum creatinine levels and height, are recommended for use in youth age 18 years and under. One is the updated Schwartz equation that takes the blood urea nitrogen (BUN) level into consideration.
The eGFR equations are not valid for those who are 70 years of age or older because muscle mass normally decreases with age.
See "Could I calculate my own eGFR?" under Common Questions for more information about these eGFR equations.
The estimated glomerular filtration rate (eGFR) is used to screen for and detect early kidney damage, to help diagnose chronic kidney disease (CKD), and to monitor kidney status.
The National Kidney Disease Education Program, American Society of Nephrology, and the National Kidney Foundation all recommend that an eGFR be calculated every time a creatinine blood test is done. The creatinine test is ordered frequently as part of a routine comprehensive metabolic panel (CMP) or basic metabolic panel (BMP), or along with a blood urea nitrogen (BUN) test to evaluate the health of your kidneys.
Creatinine, along with eGFR, is often used to monitor people with known CKD and those with conditions such as diabetes and high blood pressure (hypertension) that may lead to kidney damage.
The eGFR calculated using cystatin C is used similarly to creatinine-based eGFR. Cystatin C is not a part of the routine testing and may not be offered by all clinical laboratories. Your healthcare professional will decide if you may benefit from this additional testing.
A creatinine test and eGFR may be ordered when a healthcare practitioner wants to evaluate your kidney function as part of a health checkup or if kidney disease is suspected. Signs and symptoms of kidney disease may include:
As kidney disease worsens, symptoms may include:
An eGFR may be repeated if the initial result is abnormal to see if it persists.
The test is usually ordered periodically when you have chronic kidney disease (CKD) or a condition such as diabetes or hypertension that is associated with an increased risk of kidney damage.
Estimated GFR results are reported as milliliters/minute/1.73m2 (mL/min/1.73m2). Because some laboratories do not collect information on a patient's race when the sample is collected for serum creatinine testing, they may report calculated results for both African Americans and non-African Americans. The healthcare practitioner uses the result that applies to you in order to interpret the results correctly.
A normal eGFR for adults is greater than 90 mL/min/1.73m2, according to the National Kidney Foundation. (Clinical laboratories that use the MDRD equation to calculate eGFR will only report actual values that are less than 60 mL/min/1.73m2 because MDRD works best for estimating reduced kidney function. Clinical laboratories that use CKD-EPI equations often report all numerical values.)
An eGFR below 60 mL/min/1.73m2 suggests that some kidney damage has occurred. The test may be repeated to see if the abnormal result persists. Chronic kidney disease is diagnosed when you have an eGFR less than 60 mL/min/1.73m2 for more than three months.
You may have some kidney damage even with an eGFR greater than 90 mL/min/1.73m2. Other evidence, such as increased urine albumin, may indicate some degree of kidney damage. Thus, your eGFR should be interpreted in relation to your medical history and signs and symptoms.
The following table summarizes estimated GFR and the stages of kidney damage:
|Kidney damage stage||description||estimated gfr†||other findings|
|1||Normal or minimal kidney damage with normal GFR||90+||Protein or albumin in urine may be high, cells or casts rarely seen in urine (see Urinalysis)|
|2||Mild decrease in GFR||60-89||Protein or albumin in urine may be high, cells or casts rarely seen in urine|
|3||Moderate decrease in GFR||30-59||High blood pressure, anemia, abnormal serum calcium, potassium, phosphate|
|4||Severe decrease in GFR||15-29||High blood pressure, anemia, bone disease (CKD-MBD*) with abnormal serum calcium, phosphorous, vitamin D, parathyroid hormone|
* CKD-MBD: Chronic Kidney Disease-Mineral and Bone Disorder
Other tests that may be done to help detect kidney damage and/or evaluate kidney function are:
The creatinine clearance test also provides an estimate of kidney function and of the actual GFR. However, in addition to the serum creatinine, this test requires a timed urine collection (24 hours) for urine creatinine measurement in order to compare blood and urine creatinine concentrations and to calculate the clearance.
The best method for directly determining the GFR is a procedure called an "inulin clearance." It involves introducing a fluid containing the marker molecule inulin (NOT insulin) into your veins (IV – intravenous infusion) and then collecting timed urines over a period of hours. The urine volumes are noted and the inulin in each sample is measured to allow determination of the GFR. This test and other methods of determining GFR, such as those that use radioactive markers, are not routinely ordered and are primarily performed in research settings.
If you have had a recent creatinine or cystatin C measurement, you can calculate the eGFR by using one of the calculators for people 19 years of age or older on the National Kidney Foundation (NKF) website. If you have questions about the interpretation of your results, it is best to consult with your healthcare provider. For children and teens younger than 19, see the pediatric eGFR calculator on the NKF website.
The tables below summarize eGFR equations currently in use.
ADULT eGFR EQUATIONS (19 and over)
|CKD-EPI (2009)||Creatinine||KDIGO, NIDDK, NKF||
|CKD-EPI (2012)||Cystatin C||KDIGO, NKF||
|CKD-EPI (2012)||Creatinine and Cystatin C||KDIGO, NKF||
PEDIATRIC eGFR EQUATIONS (18 and under)
|SCHWARTZ (Updated Bedside)||Creatinine||KDIGO, NKF, NIDDK||Most commonly used equation to estimate eGFR in younger people.|
|SCHWARTZ (Modified)||Creatinine, BUN||KDIGO|
|Cystatin C-based equations||Cystatin C||Pediatric equations derived using cystatin C results were based on testing not yet calibrated to the reference material. Overestimation in eGFR may be observed.|
CKD-EPI - Chronic Kidney Disease Epidemiology Collaboration; KDIGO - Kidney Disease Improving Global Outcomes; NIDDK - National Institute of Diabetes and Digestive and Kidney Diseases; NKF - National Kidney Foundation
This practice is recommended and has been adopted by most laboratories. The eGFR can always be calculated at your healthcare provider's request.
Besides for periodic monitoring, the eGFR might be repeated if your healthcare provider feels that a temporary condition may be affecting your results.
Diabetics and others at risk for developing kidney disease may be monitored for small amounts of albumin in their urine by performing a urine albumin test. The presence of albumin and other plasma proteins as well as blood in the urine can all be signs of potential kidney damage.
This is because these factors are known to affect the level of creatinine in the blood. Creatinine is a waste product produced by muscles from the breakdown of a compound called creatine. According to the National Kidney Foundation, men tend to have more muscle mass than women so their creatinine levels tend to be higher. African Americans have a higher average muscle mass and generate more creatinine. As we age, we lose muscle mass and thus have lower blood creatinine levels for the same kidney function the older we get.
The actual amount of creatinine that you produce and eliminate is affected by your muscle mass and by the amount of protein in your diet. Men tend to have higher creatinine levels than women and children.
A person's GFR decreases with age and some illnesses. The GFR usually increases during pregnancy.
The eGFR may be affected by a variety of drugs, such as gentamicin, cisplatin, and cefoxitin, that increase creatinine levels, and by any condition that decreases blood flow to the kidneys.
The calculation of eGFR is intended to be used when kidney function and creatinine/cystatin C production are stable. If a creatinine or cystatin C level is measured when the kidney function is changing rapidly, such as with acute kidney injury, then it will not give a useful estimate of the filtration rate.
Sources Used in Current Review
2020 review completed by Eleonora Petryayeva, PhD.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3:1-150. Available online at https://kdigo.org/guidelines/ckd-evaluation-and-management/. Accessed April 12, 2020.
KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD. Am J Kidney Dis 2014;63:713-735. Available online at https://kdigo.org/guidelines/ckd-evaluation-and-management/. Accessed April 12, 2020.
National Kidney Foundation (NKF). Available online at https://www.kidney.org/kidneydisease/siemens_hcp_quickreference; https://www.kidney.org/atoz/content/gfr; and https://www.kidney.org/news/monthly/wkd_aging. Accessed April 12, 2020.
National Institute of Diabetes and Digestive and Kidney Diseases (NIKKD). Available online at https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd; https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/prevention; and https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis. Accessed April 12, 2020.
American Diabetes Association (ADA). Position Statement – 11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes−2020. Diabetes Care 2020 Jan; 43(Supplement 1): S135-S151. https://doi.org/10.2337/dc20-S011. Available online at https://care.diabetesjournals.org/content/43/Supplement_1/S135. Accessed April 12, 2020.
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States. Available online at http://www.cdc.gov/ckd. Accessed April 12, 2020.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD–MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD–MBD). Kidney International 2009; 76 (Suppl 113): S1–S130. Available online at https://kdigo.org/guidelines/ckd-mbd/. Accessed April 12, 2020.
W Greg Miller, Lorin M Bachmann, Joris R Delanghe, Lesley A Inker, Graham R D Jones, Joseph A Vassalotti. Optimal Use of Biomarkers for Chronic Kidney Disease. Clinical Chemistry, Volume 65, Issue 8, 1 August 2019, Pages 949–955. Available online at https://doi.org/10.1373/clinchem.2018.299073. Accessed April 2020.
Gaitonde, D.; Cook, D.; Rivera, I. Chronic Kidney Disease: Detection and Evaluation. American Family Physician 2017, 96, 776-783. Available online at https://www.aafp.org/afp/2017/1215/p776.html. Accessed April 2020.
Toffaletti, J. Relationships and Clinical Utility of Creatinine, Cystatin C, eGFRs, GFRs, and Clearances. The Journal of Applied Laboratory Medicine 2017, 2, 413-422. Available online at https://academic.oup.com/jalm/article/2/3/413/5587526. Accessed April 2020.
Mallappallil, M., Friedman, E. A., Delano, B. G., McFarlane, S. I., & Salifu, M. O. (2014). Chronic kidney disease in the elderly: evaluation and management. Clinical practice (London, England), 11(5), 525–535. Available online at https://doi.org/10.2217/cpr.14.46. Accessed April 2020.
Emil den Bakker, Reinoud J. B. J. Gemke & Arend Bökenkamp (2018). Endogenous markers for kidney function in children: a review. Critical Reviews in Clinical Laboratory Sciences, 55:3, 163-183, DOI: 10.1080/10408363.2018.1427041.
Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 6th Edition, Elsevier 2018. Cystatin C – Ch. 32 Kidney Function Tests, p. 495-497. Accessed online through ExpertConsult.
Sources Used in Previous Reviews
National Kidney Foundation. DOQI: Clinical Practice Guidelines. Available online at http://www.kidney.org/professionals/kdoqi/guidelines.
National Kidney Foundation. Glomerular Filtration Rate. Available online at http://www.kidney.org/kidneydisease/ckd/knowGFR.cfm.
National Kidney Foundation. Kidney Learning System: GFR. Available online at http://www.kidney.org/professionals/KLS/gfr.cfm.
Levey et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Annals of Internal Medicine. 1999; 130(6):461-470.
Clarke, W. and Dufour, D. R., Editors (© 2006). Contemporary Practice in Clinical Chemistry: AACC Press, Washington, DC. Pp 311-312.
Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 438-439.
Patel, P. (Updated 2009 August 12). Glomerular filtration rate. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/007305.htm. Accessed October 2009.
(2009 February). The Kidneys and How They Work. National Kidney and Urologic Diseases Information Clearinghouse [On-line information]. Available online at http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/. Accessed October 2009.
(Reviewed 2009 April 7). Laboratory Professionals, Estimating and Reporting GFR. National Kidney Disease Education Program [On-line information]. Available online at http://www.nkdep.nih.gov/labprofessionals/estimate_report_gfr.htm. Accessed October 2009.
Delgado, J. (Updated 2009 August). Renal Function Markers - Kidney Disease. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/RenalFunctionMarkers.html?client_ID=LTD#. Accessed October 2009.
(© 2007). Estimated Glomerular Filtration Rate (eGFR), in the Detection and Assessment of Chronic Kidney Disease in Adults. LabCorp Technical Review [On-line information]. PDF available for download at https://www.labcorp.com/pdf/Estimated_Glomerular_Filtration_Rate_eGFRL1137_1207_2.pdf. Accessed October 2009.
(Reviewed 2007 October). Glomerular Filtration Rate, Estimated (eGFR). Quest Diagnostics Test Summary [On-line information]. Available online at http://www.questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=TS_eGFR.htm. Accessed October 2009.
Turin, T. et. al. (2013) Change in the Estimated Glomerular Filtration Rate Over Time and Risk of All-Cause Mortality. Medscape Today News from Kidney Int. v83 (4):684-691 [On-line information]. Available online at http://www.medscape.com/viewarticle/782622. Accessed July 2013.
Simon, J. et. al. (2011 March). Interpreting the estimated glomerular filtration rate in primary care: Benefits and pitfalls. Cleveland Clinic Journal of Medicine v78 (3) 189-195. [On-line information]. Available online at http://www.ccjm.org/content/78/3/189.full. Accessed July 2013.
(© 1995–2013). Cystatin C with Estimated GFR, Serum. Mayo Clinic Mayo Medical Laboratory Interpretive Handbook [On-line information]. Available online at http://www.mayomedicallaboratories.com/interpretive-guide/?alpha=C&unit_code=35038. Accessed July 2013.
(Updated 2012 July 10) For People with Diabetes or High Blood Pressure: Get Checked for Kidney Disease. National Kidney Disease Education Program [On-line information]. Available online at http://www.nkdep.nih.gov/resources/get-checked-kidney-disease.shtml. Accessed July 2013.
Dugdale, D. (Updated 2011 September 19). Glomerular filtration rate. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/007305.htm. Accessed July 2013.
Shah, A. (Revised 2013 May). Evaluation of the Renal Patient. Merck Manual for Healthcare Professionals [On-line information]. Available online through http://www.merckmanuals.com. Accessed July 2013.
Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 329-333.
Clarke, W., Editor (© 2011). Contemporary Practice in Clinical Chemistry 2nd Edition: AACC Press, Washington, DC. Pp 362-364.
McPherson, R. and Pincus, M. (© 2011). Henry's Clinical Diagnosis and Management by Laboratory Methods 22nd Edition: Elsevier Saunders, Philadelphia, PA. Pp 173-177.
National Kidney Disease Education Program. Estimating GFR. Available online at http://nkdep.nih.gov/lab-evaluation/gfr/estimating.shtml. Accessed October 2013.
National Kidney Foundation. Cystatin C: What is its role in estimating GFR? Available online at http://www.kidney.org/professionals/tools/pdf/CystatinC.pdf. Accessed October 2013.
Weber, CL et al. Demystifying chronic kidney disease: Clinical caveats for the family physician. BCMJ, Vol. 50, No. 6, July, August 2008, page(s) 304-309. Available online at http://www.bcmj.org/article/demystifying-chronic-kidney-disease-clinical-caveats-family-physician. Accessed January 2015.
(2016) National Kidney Foundation. GFR Calculator. Available online at https://www.kidney.org/professionals/KDOQI/gfr_calculator. Accessed June 19, 2016.
(2014) National Kidney Foundation. Frequently Asked Questions about GFR Estimates. Available online at https://www.kidney.org/sites/default/files/docs/12-10-4004_abe_faqs_aboutgfrrev1b_singleb.pdf. Accessed June 19, 2016.
(April 2015) National Institute of Diabetes and Digestive and Kidney Diseases. Estimating Glomerular Filtration Rate (GFR). Available online at http://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/lab-evaluation/gfr/estimating/Pages/estimating.aspx#the-mdrd-equation. Accessed June 20, 2016.
(April 2015) Medscape. Chronic Kidney Disease Workup. Available online at http://emedicine.medscape.com/article/238798-workup#c8. Accessed June 23, 2016.
NFK KDOQI Guidelines. Available online at http://www2.kidney.org/professionals/KDOQI/guidelines_ckd/p4_class_g1.htm. Accessed June 2016.
Mayo Clinic. Creatinine with Estimated GFR (MDRD), Serum. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/8472. Accessed June 2016.
Mayo Clinic. Interpretive Handbook. Test 8472: Creatinine with Estimated GFR (MDRD), Serum. Available online at http://www.mayomedicallaboratories.com/interpretive-guide/?alpha=C&unit_code=8472. Accessed June 2016.
NIH National Institute of Diabetes and Digestive and Kidney Diseases. Estimating Glomerular Filtration Rate (GFR). Available online at http://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/lab-evaluation/gfr/estimating/Pages/estimating.aspx. Accessed June 2016.
NIH National Institute of Diabetes and Digestive and Kidney Diseases. Reporting Glomerular Filtration Rate (GFR). Available online at http://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/lab-evaluation/gfr/reporting/Pages/reporting.aspx. Accessed June 2016.
American Kidney Fund. Tests for kidney health. Available online at http://www.kidneyfund.org/prevention/tests-for-kidney-health/?referrer=https://www.google.com/. Accessed June 2016.
American Kidney Fund. Blood test: eGFR. Available online at http://www.kidneyfund.org/prevention/tests-for-kidney-health/egfr-test.html. Accessed June 2016.
Quest Diagnostics. Test Center: Creatinine-based Estimated Glomerular Filtration Rate (eGFR). Available online at http://www.questdiagnostics.com/testcenter/testguide.action?dc=TS_eGFR. Accessed June 2016.