What criteria should I use to refer a patient with CKD to a nephrologist?

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) ³.

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 ³.

Refer adults if there is a sustained decrease in eGFR of 15 mL/min/1.73 m² or more within 12 months ³.

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 ³.

Refer adults if hypertension remains poorly controlled despite the use of at least four antihypertensive medicines at therapeutic doses ¹.

Refer adults if there are known or suspected rare or genetic causes of CKD or suspected renal artery stenosis ¹.

Refer to urology for people with renal outflow obstruction, unless urgent treatment is needed ¹.

Consider referral if there are concerns but the patient does not meet all criteria, by discussing management with a specialist ¹.