A patient’s GFR is 18 mL/min/1.73 m2. This finding most likely indicates which stage/condition requiring specific management?

• A. End-stage renal disease requiring dialysis
• B. Stage 3 CKD
• C. Stage 1 CKD
• D. Acute kidney injury

Answer: (A)

Understanding how GFR maps to CKD stages helps you predict the level of management needed. A GFR of 18 mL/min/1.73 m2 indicates stage 4 CKD, a severe reduction in kidney function. In stage 4, the kidneys are not able to maintain normal balance and waste removal, so clinicians start planning for renal replacement therapy. That planning typically involves evaluating for dialysis or transplant and coordinating with nephrology, while also aggressively managing blood pressure, diabetes, electrolytes, anemia, bone-mineral disorders, and other complications. Because of this need for definitive renal replacement planning, the choice describing end-stage renal disease requiring dialysis best matches the care trajectory at this level of kidney function. This differs from stage 3 or stage 1 CKD, which reflect less severe impairment, and from acute kidney injury, which is an abrupt, often reversible decline.