Suggested Criteria/Guidelines for PCP Referral to Nephrology:
Introduction
CKD management is a great challenge for both primary care physicians and for nephrologists. This challenge increases when patients are referred late to a nephrologist. Delayed referral leads to more rapid progression to ESRD and in some cases acute dialysis with higher morbidity, mortality and excessive cost.
Target population
Adults >18 years of age with chronic kidney disease
Clinical Goal
Slow down the progression of CKD to ESRD and lower the risk of adverse ASCVD outcomes
Criteria for referral to a Nephrologist
- GFR < 45ml/min (Stage 3b CKD) with or without abnormal urinary findings
- GFR < 60ml/min (Stage 3a CKD) with albuminuria, proteinuria, pyuria or microscopic hematuria
- GFR <60 ml/min with diabetes or uncontrolled hypertension (patient requiring >3 drugs for BP control)- CKD with CHF and fluid management issues
- Unexplained proteinuria, microscopic hematuria irrespective of GFR
- CKD with rapid decline in GFR
- Electrolyte abnormalities
- Severe metabolic acidosis
- Patient with kidney transplant
- CKD with mineral bone disease – elevated PTH and Phosphorus
- Abnormal renal ultrasound or CT scan
Relative criteria for referral to a Nephrologist
- GFR < 60ml- Stage 3a- CKD patients enrolled in CKD comprehensive care program have a significant delay in the onset of ESRD, longer life expectancy once on dialysis and are more likely to receive a renal transplant.
- New AKI – declining GFR > 25% from baseline
Follow up of CKD patients
- Stage 3a (GFR <60 ml/min)- Every 4 months
- Stage 3b (GFR <45 ml/min)- Every 3 months
- Stage 4 (GFR <30 ml/min)- Every 2 months
- Stage 5 (GFR <15 ml/min)- Every month
