How often should GFR be monitored in patients with chronic kidney disease (CKD) stages 1-3?

For patients with chronic kidney disease (CKD) stages 1 to 3, the frequency of monitoring glomerular filtration rate (eGFRcreatinine) should be tailored based on their GFR and albumin:creatinine ratio (ACR) categories, underlying cause of CKD, rate of decline in eGFR or increase in ACR, other risk factors, treatment changes, intercurrent illness, and patient preferences.

Specifically, according to NICE guideline NG203, the minimum number of eGFRcreatinine monitoring checks per year for adults with CKD stages 1 to 3 is as follows:

• For GFR category G1 (≥90 ml/min/1.73 m²) with ACR category A1 (normal to mildly increased, <3 mg/mmol), 0 to 1 monitoring checks per year are recommended.
• For GFR category G1 with ACR category A2 or A3, at least 1 or more monitoring checks per year are recommended.
• For GFR category G2 (60 to 89 ml/min/1.73 m²) with ACR category A1, 0 to 1 monitoring checks per year are recommended.
• For GFR category G2 with ACR category A2 or A3, at least 1 or more monitoring checks per year are recommended.
• For GFR category G3a (45 to 59 ml/min/1.73 m²), 1 monitoring check per year is recommended for ACR A1 or A2, and 2 or more for ACR A3.

Monitoring frequency should be individualized and may be increased if there is accelerated progression, changes in treatment, or other clinical factors.

Therefore, for CKD stages 1 to 3, monitoring frequency ranges from 0 to 2 or more times per year depending on GFR and ACR categories and clinical context.

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