VA/DoD Indications for Referring a Patient with Chronic Kidney Disease to a Nephrologist

Patient selection: chronic kidney disease (CKD)

Indications for referral of the patient to a nephrologist:

(1) eGFR less than 30 mL per min per 1.73 square meter

(2) rapid decline in the eGFR

(3) complications of chronic kidney disease (anemia, phosphorus abnormalities, secondary hyperparathyroidism)

(4) nephrotic range proteinuria (> 3.5 grams per 24 hours)

(5) underlying cause for the renal disease is uncertain

(6) primary care provider feels uncomfortable in managing the patient

(7) nephrolithiasis

(8) suspected cause of the renal disease requires specialized care

where:

• Nephrolithiasis is listed under Recommendation 16 of the full guidelines.

• Rapid decline in the GFR was defined as a decrease > 5 mL per min per 1.73 sq meter per year.