- 26 million estimated people in the US have chronic kidney disease (“CKD”)
- Many more are at risk from diabetes, hypertension, family history of kidney disease, and age > 60 years
- Kidney disease kills more people than breast or prostate cancer
- Early referral to nephrology slows or prevents CKD progression. It halves mortality in some studies!
Reasons to refer for patient safety, adapted from the National Kidney Foundation:
Refer by CKD criteria:
- Marker of kidney damage (one or more)
- Estimated glomerular filtration rate (eGFR) <60 mL/min
- (mandatory < 30mL/min)
- Radiographic or symptomatic abnormality of kidney structure
- Dysfunction persisting >3 mos
Refer by CKD risk factors:
- Diabetes > 5 years
- Hypertension > 5 years or difficult to control
- Family history of kidney disease
- Age > 60 years (kidney function declines with age)
- Frequent usage of NSAIDs or nephrotoxic medications/drugs
- History of AKI (acute kidney injury)
- Medication errors (toxicity, improper dosing, inadequate monitoring)
- Electrolyte disturbances
- Diagnostic tests (contrast studies, bowel preps, etc)
- Fluid management (hypotension, volume excess, complex heart failure patients)
- Augmenting patient awareness of risks (ie, NSAIDs, supplements)
- Vessel preservation (for future dialysis access)
Impact of early primary care CKD detection for patient safety
Altitude Kidney Health is a nephrology practicefounded in 2018 with a goal to decrease the barriers to kidney care for all residents of the greater Rocky Mountain region. AKH has offices in Denver and Frisco, CO, and is available Monday-Friday for consult via in-person and telehealth video visit—for providers & patients.
We are happy to co-manage or provide a second opinion. Please reach us using our contact info below or on-demand video consult.
Printable PDF of "When to refer to a nephrologist."