The key issues in managing CKD are ensuring that the diagnosis is correct, implementing appropriate therapy, and monitoring the patient. Except for very advanced CKD, most of the therapeutic interventions are similar to optimal diabetes or CVD care. The most important additional interventions are screening for comorbid conditions and providing education to the patient on the progressive nature of kidney disease, the eventual need for renal replacement therapy, and dietary modification. These may be facilitated by referral to a nephrologist but can be effectively accomplished by a primary provider and a registered dietitian who have a long-term relationship with the patient.
It may be appropriate to consult with a nephrologist to
- assist with a diagnostic challenge (e.g., decision to biopsy)
- assist with a therapeutic challenge (e.g., blood pressure, anemia, mineral and bone disorders hyperkalemia, hyperphosphatemia, secondary hyperparathyroidism, malnutrition)
- assess rapid decrease of eGFR
- treat most primary kidney diseases, (e.g., glomerulonephritis)
- prepare for renal replacement therapy, especially when eGFR is less than 30 mL/min/1.73 m2
The timing of referral may vary depending on patient status as well provider experience. Regardless of the timing of the referral, providers should
- obtain preliminary evaluation (e.g., ultrasound, screening serologies)
- provide the consultant with patient history including serial measures of renal function and urine albumin
- inform the patient that he/she is being referred to a nephrologist and the reason for referral
Use the NKDEP Nephrology Referral Form to share important patient data with the consulting nephrologist.
Collaborative management by primary providers and consultants may maintain continuity of care and improve outcomes. Most nephrologists will welcome the opportunity to assist in the management of CKD patients who have benefited from early diagnosis and intervention. Effective communication between providers will facilitate collaborative care.