Rationale for Guideline for "Time of referral to Nephrologists"

Time of Referral to Nephrologists

Contribution from the 2001 KDOQI Workgroup on Classification of CKD

Source: Guideline #2 of the 2002 KDOQI Clinical Practice Guideline for CKD: Evaluation Classification and Stratification. Am J Kidney Dis, February 2002.

Opinion-Based Guideline: Patients with chronic kidney disease should be referred to a specialist for consultation and co-management if the clinical action plan cannot be prepared, the prescribed evaluation of the patient cannot be carried out, or the recommended treatment cannot be carried out. In general, all patients with GFR <30 mL/min/1.73 m2 should be referred to a nephrologists in order to initiate planning for dialysis or transplantation.

Rationale: Referral to specialists: Frequently the primary care provider will make the diagnosis of chronic kidney disease. Referral to a nephrologist or other specialist for consultation or co-management should be made after diagnosis under the following circumstances: a clinical action plan cannot be prepared based on the stage of the disease, the prescribed evaluation of the patient cannot be carried out, or the recommended treatment cannot be carried out. These activities may not be possible either because the appropriate tools are not available or because the primary care physician does not have the time or information needed to do so. In general, all patients with GFR <30 mL/min/1.73 m2 (CKD Stages 4-5) should be referred to nephrologists in order to initiate planning for dialysis or transplantation.

Prepared on behalf of the National Kidney Foundation KDOQI workgroup by Michael Rocco (KDOQI Vice-Chair).