What Are the Creatinine Levels Indicative of Uremia?

Understanding kidney health often begins with monitoring creatinine levels, a key marker used to assess renal function. Traditionally, in China, chronic kidney disease (CKD) progression was classified primarily based on serum creatinine values. When blood creatinine remains below 178 μmol/L, it typically indicates the compensatory stage of chronic renal failure—where the kidneys still manage to maintain normal function despite underlying damage.

Stages of Kidney Failure Based on Creatinine Levels

Nitrogenemia Phase ( Decompensated Stage )

Blood creatinine levels ranging between 178 and 440 μmol/L suggest the decompensation phase of chronic kidney failure, also known as the azotemic stage. At this point, the kidneys can no longer fully compensate for lost function, leading to a buildup of waste products like urea and creatinine in the bloodstream.

Renal Failure Stage

When creatinine rises to between 440 and 707 μmol/L, patients are generally categorized as being in the renal failure stage. Symptoms such as fatigue, swelling, changes in urination, and nausea become more noticeable due to significant toxin accumulation.

Uremic Stage

A serum creatinine level exceeding 707 μmol/L is clinically recognized as the uremic stage—the most advanced form of kidney failure. This condition often requires immediate medical intervention, including dialysis or kidney transplantation, to sustain life.

Modern Classification Using eGFR

Today, global medical standards have shifted toward a more accurate and individualized method of evaluating kidney function using estimated Glomerular Filtration Rate (eGFR). Unlike raw creatinine numbers, eGFR takes into account factors such as age, sex, body size, and race, offering a clearer picture of actual kidney performance.

Stage 1 CKD: Normal or High GFR

An eGFR between 90 and 120 mL/min/1.73m² corresponds to Stage 1 chronic kidney disease, indicating normal kidney function—even if structural damage (such as proteinuria) is present. Monitoring at this stage helps prevent further deterioration.

Early Signs of Kidney Dysfunction

An eGFR below 60 mL/min/1.73m² for three months or longer signals moderate chronic kidney disease, reflecting impaired filtration capacity. This threshold is widely accepted as the benchmark for diagnosing persistent kidney dysfunction, regardless of symptoms.

End-Stage Renal Disease (ESRD)

When eGFR drops below 15 mL/min/1.73m², the patient has reached end-stage renal disease—commonly referred to as uremia. At this critical juncture, renal replacement therapy such as hemodialysis, peritoneal dialysis, or kidney transplant becomes essential for survival.

While serum creatinine remains a useful screening tool, eGFR provides a far more comprehensive assessment of kidney health. Regular testing is especially important for individuals with diabetes, hypertension, or a family history of kidney disease. Early detection and management can significantly delay or even prevent progression to uremia.