Rationale for Guideline for "Time of referral to Nephrologists"

Time of Referral to Nephrologists

Contribution from the Caring for Australians with Renal Impairment (CARI) Guidelines Committee

The 1999 CARI guideline on early referral of pre-ESRD patients recommends:

• Patients with Ccrea < 30 ml/min/1.73m2 should be referred to a nephrologist
• Earlier referral should be considered in patients who are hypertensive or who have significant proteinuria (>1g/24hours)

Rationale: The CARI guidelines relating to the timing of referral to a nephrologist are consistent with those of other kidney disease guidelines groups in their recommendation that all patients with a GFR <30 be referred (the UK Guidelines use serum creatinine rather than GFR). All the other guidelines in this area are ‘opinion based’ or ‘good practice’, recognising the poverty of good scientific evidence for these recommendations.

This CARI guideline, developed in 1999, cites Level B evidence as, at that time, CARI was using a simplified version of the Australian National Health and Medical Research Council (NHMRC) rules for grading evidence. Under the current NHMRC evidence classification method used by CARI, introduced following changes made in 2001, the evidence supporting this guideline would be classified as Level III (evidence derived from descriptive studies) and the guideline would likely be called a ‘Suggestion for Clinical Care’ rather than a ‘Guideline’.

Prepared on behalf of CARI by Paul Snelling and John Collins, Conveners of the CARI Early referral of pre-ESRD Patients Guidelines Working Group