Population-Based eGFR Percentiles Linked to Kidney Failure and Mortality Risk, Study Finds

Estimated glomerular filtration rate (eGFR) values below the 25th percentile for age and sex were associated with significantly higher risks of kidney failure requiring replacement therapy and death, according to a large population-based cohort study published in Kidney International. The findings suggest that population-level eGFR distributions may help identify individuals at elevated risk for chronic kidney disease (CKD) earlier than current threshold-based approaches.

Investigators analyzed data from the Stockholm CREAtinine Measurements (SCREAM) project, which captured health care and laboratory records from approximately 80% of adults aged 40 to 100 years living in the Stockholm region between 2006 and 2021. The cohort included 1 179 501 unique individuals with nearly 6.9 million repeated annual eGFR measurements, allowing construction of age- and sex-specific eGFR percentile distributions.¹

Currently, CKD detection in routine practice relies largely on opportunistic screening through serum creatinine testing and automatic eGFR reporting, with diagnosis often triggered when eGFR falls below 60 ml/min per 1.73 m². The study authors noted that this approach may delay recognition until substantial kidney function has already been lost.¹

“We were inspired by the growth and weight charts used in paediatrics, which intuitively help clinicians identify children at risk of obesity or undergrowth,” first author, Yuanhang Yang, postdoctoral researcher at the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, said in a press release.²

eGFR distributions and clinical outcomes

Using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation, median eGFR declined progressively with age, from approximately 104–106 ml/min per 1.73 m² at age 40 to 45–50 ml/min per 1.73 m² at age 100. When eGFR percentiles were evaluated relative to age- and sex-matched peers, values below the 25th percentile were significantly associated with increased risk of kidney failure with replacement therapy compared with individuals in the central percentiles.¹

During a median follow-up of 10 years, the investigators identified 2 651 kidney failure events and 223 875 deaths. Absolute 10-year risk of kidney failure remained low overall but was higher among individuals below the 25th percentile compared with those in the middle of the distribution. Mortality demonstrated a U-shaped association, with both low and high eGFR percentiles linked to higher death rates.¹

Missed opportunities for early evaluation

Among more than 421 000 individuals with eGFR values of at least 60 ml/min per 1.73 m² who nonetheless fell below the 25th percentile for their age and sex, only 24% underwent albuminuria or proteinuria testing in the year before or after the low percentile eGFR measurement. The authors noted that these patients may have benefited from additional diagnostic evaluation despite not meeting conventional CKD thresholds.¹

Adjustment for albuminuria attenuated, but did not eliminate, the association between low eGFR percentiles and kidney failure risk, suggesting that albuminuria may partially mediate the observed outcomes.¹

Implications for clinical practice

The authors concluded that population-based eGFR percentile charts could complement existing automatic eGFR reporting systems, similar to growth charts or spirometry reference values, to support earlier identification of patients at increased risk for CKD. Such an approach could prompt more targeted albuminuria testing and earlier preventive interventions, particularly in patients whose absolute eGFR values fall within ranges currently considered normal.¹

The investigators emphasized that further validation in other populations and health systems is needed before broad clinical implementation but suggested that age- and sex-specific eGFR distributions may represent a practical tool to improve primary prevention strategies for CKD.¹

References:

1. Yuanhang Yang, Antoine Creon, Andrew S Levey, 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. Kidney International. Published online January 16, 2026. doi:10.1016/j.kint.2025.11.009
2. Simple method can enable early detection and prevention of chronic kidney disease. Karolinska Institutet. Press release. January 16, 2026. Accessed January 19, 2026. https://www.eurekalert.org/news-releases/1112495