What are the key indicators for referring a patient with suspected chronic kidney disease 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.
• An albumin:creatinine ratio (ACR) of 70 mg/mmol or more, unless caused by diabetes and managed appropriately ³.
• An ACR of more than 30 mg/mmol (ACR category A3), together with haematuria ³.
• A sustained decrease in eGFR of 25% or more and a change in eGFR category within 12 months ³.
• A sustained decrease in eGFR of 15 ml/min/1.73 m2 or more per year ³.
• Hypertension that remains poorly controlled despite the use of at least 4 antihypertensive medicines at therapeutic doses ¹.
• Known or suspected rare or genetic causes of CKD ¹.
• Suspected renal artery stenosis ¹.