Refer adults with CKD for specialist assessment if they have a 5-year risk of needing renal replacement therapy of greater than 5% (measured using the 4-variable Kidney Failure Risk Equation) NICE NG203.
Refer adults with CKD if there is a sustained decrease in eGFR of 25% or more within 12 months and a change in CKD category NICE NG203.
Refer adults if there is a sustained decrease in eGFR of 15 mL/min/1.73 mNICE CKS or more within 12 months NICE NG203.
Refer adults if the urinary albumin:creatinine ratio (ACR) is 70 mg/mmol or more, unless proteinuria is known to be associated with diabetes mellitus and is managed appropriately NICE NG203.
Refer adults if hypertension remains poorly controlled despite the use of at least four antihypertensive medicines at therapeutic doses NICE CKS.
Refer adults if there are known or suspected rare or genetic causes of CKD or suspected renal artery stenosis NICE CKS.
Refer to urology for people with renal outflow obstruction, unless urgent treatment is needed NICE CKS.
Consider referral if there are concerns but the patient does not meet all criteria, by discussing management with a specialist NICE CKS.