Understanding Population-Based eGFR Distributions for Early Identification and Prevention of Chronic Kidney Disease

Chronic kidney disease, commonly referred to as CKD, is a global health concern affecting over 850 million individuals worldwide. It is projected to become the fifth leading cause of years of life lost by 2040. People with CKD are at higher risk for serious health issues, including kidney failure requiring dialysis or transplantation, cardiovascular diseases, cancer, severe infections, and premature death. CKD also significantly reduces quality of life, shortens life expectancy, and places a heavy economic burden on healthcare systems. Early identification and prevention of CKD are critical to reduce its impact, yet current strategies remain limited.

One method for identifying CKD is through estimating glomerular filtration rate, or eGFR, from routine serum creatinine measurements. Automatic eGFR reporting has been in use since the early 2000s and has improved awareness of CKD, resulting in increased referrals to nephrology specialists. However, relying solely on a fixed eGFR threshold, such as below 60 ml/min per 1.73 m2, may detect CKD at later stages, often after significant kidney function has already been lost. Identifying individuals at risk before reaching this threshold could provide opportunities for early intervention and primary prevention.

A recent population-based study conducted in Stockholm, Sweden, explored the concept of using population-wide eGFR distributions to identify individuals at higher risk for CKD and associated adverse health outcomes. The study, known as the Stockholm CREAtinine Measurements (SCREAM) project, included over 1.1 million adults aged 40 to 100 years and analyzed nearly seven million repeated annual eGFR measurements collected between 2006 and 2021. This cohort represented approximately 80 percent of the adult population in the region, making the data highly representative.

The researchers calculated eGFR distributions for the population, stratified by age and sex. They found that the median eGFR decreased with age, ranging from approximately 104 to 106 ml/min per 1.73 m2 at age 40 to 45 to 50 ml/min per 1.73 m2 at age 100. Excluding individuals with common comorbid conditions or adjusting for the non-tested population had minimal impact on these distributions. Interestingly, while the majority of adults had eGFR values above 60 ml/min per 1.73 m2, the study revealed that deviations from the median distribution were associated with increased risks of adverse outcomes.

Specifically, individuals with eGFR values below the 25th percentile of the population distribution were at significantly higher risk for kidney failure requiring replacement therapy, or KFRT. Both low and high eGFR percentiles were linked to increased mortality. For example, among adults with eGFR values of 60 ml/min per 1.73 m2 or higher but below the 25th percentile, only 24 percent underwent albuminuria or proteinuria testing within the year, highlighting a missed opportunity for further evaluation and early intervention.

Albuminuria testing, which measures protein in the urine, is a known early indicator of kidney damage. Despite guideline recommendations, many clinicians do not routinely test for albuminuria in high-risk patients such as those with diabetes, hypertension, or cardiovascular disease. In the study, testing rates were generally low, particularly in individuals without these comorbid conditions. Among those with low eGFR percentiles and eGFR values above 60, only 17 percent of individuals without comorbidities underwent albuminuria testing, compared to 28 percent among those with lower eGFR values.

The study also demonstrated that population-based eGFR distributions could serve as a useful tool for clinical decision-making. Analogous to growth charts used in pediatrics or reference values in pulmonary function testing, these eGFR charts allow clinicians to contextualize a patient’s eGFR relative to their age and sex. This approach helps identify individuals who may benefit from additional diagnostic tests, monitoring, or lifestyle interventions before kidney function declines significantly.

The study used robust methodology, including cause-specific Cox regression models to assess the association between eGFR percentiles and risks of KFRT and all-cause mortality. Results were consistent across age groups and eGFR calculation methods, supporting the validity of the findings. The absolute 10-year risk of KFRT was higher in individuals below the 25th percentile of eGFR distribution, although overall absolute risks were low, averaging less than 1 percent. However, the absolute 10-year risk of death was approximately 17 percent in this population, increasing to 18.6 percent among those below the 25th percentile.

Notably, the study highlighted a U-shaped association between eGFR percentiles and mortality, where both low and high percentiles were linked to increased risk. This suggests that very high eGFR values may not always be benign and could indicate underlying health issues such as hyperfiltration in diabetes or low muscle mass due to frailty or cachexia. Understanding these patterns may help clinicians better interpret eGFR values and their implications for patient health.

The researchers also created an online interactive tool to facilitate the use of eGFR percentile charts in clinical practice. Clinicians can input a patient’s age, sex, and eGFR value to see where they fall within the population distribution and identify potential risk levels. This tool can enhance patient discussions, guide further testing, and inform early intervention strategies. For example, over 400,000 adults in the Stockholm region with eGFR values above 60 ml/min per 1.73 m2 were below the 25th percentile, indicating a large number of individuals who could benefit from closer monitoring and preventive care.

The study has important implications for the early detection and primary prevention of CKD. Traditional approaches often rely on fixed eGFR thresholds, which may delay intervention until significant kidney damage has occurred. By using population-based distributions, clinicians can identify at-risk individuals earlier, even when eGFR values remain within the conventional normal range. This proactive approach could improve outcomes by enabling timely interventions, including lifestyle modifications, blood pressure control, management of diabetes, and additional kidney function assessments.

There are some limitations to the study. It was conducted in a predominantly Swedish population, which may limit generalizability to more ethnically diverse populations. Additionally, the study focused on adults aged 40 years and older, as creatinine testing is less common in younger individuals. Further research is needed to establish eGFR distributions for younger populations and to validate these findings in other regions and healthcare systems.

Despite these limitations, the study provides compelling evidence that population-based eGFR distributions are a valuable tool for early identification of CKD risk. By integrating these distributions into routine clinical practice, healthcare providers can enhance CKD prevention strategies, reduce the burden of advanced kidney disease, and improve patient outcomes.

In conclusion, population-based eGFR distributions offer a novel approach to identifying individuals at risk for CKD and associated adverse outcomes. eGFR values below the 25th percentile are linked to increased risk of kidney failure and death, even among individuals with values above the conventional CKD threshold. Using eGFR charts as a complementary tool to automatic reporting can support early detection, prompt further evaluation, and facilitate primary prevention strategies. Clinicians and healthcare systems are encouraged to consider implementing these tools to improve kidney health management and patient care.

Source: Yang Y, Creon A, Levey AS, Ortiz A, Fu EL, Carrero JJ, et al. Population-based estimated Glomerular Filtration Rate distributions and associated health outcomes provide opportunities for early identification of and primary prevention of chronic kidney disease. Clinical Investigation, January 15, 2026.

Disclaimer: This article is intended for informational purposes only and should not be considered medical advice. Readers should consult a healthcare professional for individual medical guidance and decisions regarding CKD screening or treatment.