General Nephrology - Time Referral to the Nephrologist

Guideline Organization

Recommendation (Evidence Level)

Evidence

Comments

CARI-Australia
2003

Patients with Ccrea < 30 ml/min/1.73m2.
Earlier referral should be considered in patients who are hypertensive or who have significant proteinuria (>1g/24hours). (Level B)
(Target Rationale)

2. Early referral of pre-ESRD

For rationale, each time read below the guidelines.

Reasons for timely referral
- high risk progressive deterioration renal function
- specialist management of renal failure
- adequate preparation for dialysis

CSN-Canada
1999

Refer patients with Ccreat <30ml/min to a nephrologist for opinion regarding management of renal failure (Opinion)
(Target Rationale)

Elevated Creatinine Referral Guidelines
Guideline 1.1 Referral for Management of Renal Failure
P 3 of 35 PDF pages

EBPG-Europe
November 2002

A. Referral should be considered
when GFR<60ml/min and is mandatory when GFR<30ml/min
B. If GFR is not available, referral
should be when on 2 consecutive measurements Screa > 150µmol/L (1.7 mg/dL) in men and 120µmol/l (1.35 mg/dL) in women. (Opinion)
(Target Rationale)

Guideline 1.2 When to refer to a nephrology clinic
Guideline I 2.1, p 1 of 2
 

KDOQI-US
February 2004

In general, patients with GFR <30 mL/min/1.73 m2 should be referred (stage 4).  (Opinion)
(Target Rationale)

Clinical Practice Guidelines for Chronic Kidney Disease : Evaluation, classification and stratification
Part 4 : Guideline 2 Evaluation and treatment

Consultation and/or co-management with a kidney disease care team is advisable during Stage 3 (30-59ml/min), and referral to a nephrologist in Stage 4 (15-29ml/min) recommended. Kidney function may need to be monitored four times per year or more.

UK-Guidelines
August 2002

Patients with progressive RF should be referred early with Screa 150-200μmol/l (1.7-2.25 mg/dL) to enable dialysis to be started in a planned fashion. (Good Practice)

10.  The management of patients approaching end stage renal disease
Website P36 of 204 PDF pages