Low GFR? Can Your Kidney Function Actually Improve?

A low GFR can be frightening. If your GFR or eGFR is decreasing, does that mean your kidneys will inevitably continue to fail? And does a low GFR mean that dialysis is eventually unavoidable? Not necessarily. In this video, I explain what GFR (glomerular filtration rate) tells us about kidney function and examine scientific evidence showing that kidney disease does not always move in one direction. In some patients, GFR can remain stable for years—and studies have shown that kidney function can actually improve in certain circumstances. We look at four important factors that may influence GFR and the progression of chronic kidney disease:

• Diabetes and blood-sugar control

• High blood pressure

• Obesity and weight loss

• Triglycerides, saturated fats and unsaturated fats

I also discuss kidney-protective medications and why treating the conditions that are damaging your kidneys may substantially change what happens to your GFR over time. One particularly interesting long-term study followed patients with hypertensive chronic kidney disease for as long as 12 years and found a small group whose GFR showed sustained improvement. Another study involving people with obesity and chronic kidney disease found that after substantial weight loss and bariatric surgery, average GFR increased and many participants improved to a better CKD stage. The message is not that every low GFR can be reversed. The message is that a decreased GFR does not automatically mean that you are destined for dialysis. Finding out why your GFR is low—and addressing the factors continuing to injure your kidneys—may give you the best chance of preserving the kidney function you have and, in some cases, improving it. https://youtu.be/yX6YcvD6HO0

Scientific studies discussed in this video:

Kidney Function Can Improve in Patients with Hypertensive CKD https://doi.org/10.1681/ASN.2011050456

Bariatric Surgery Improves Renal Function in Patients With Obesity https://doi.org/10.7759/cureus.17458

Regulation of Podocyte Survival and Endoplasmic Reticulum Stress by Fatty Acids https://doi.org/10.1152/ajprenal.00196.2010