Diagnosis and management of non-dialysis chronic kidney disease in ambulatory care: a systematic review of clinical practice guidelines

Table 7 Recommendation summary - referral criteria

		CEBAM	ACP	HAS	KDIGO	KHA-CARI	BCMA	UMHS	VA-DoD	NICE
		2012	2013	2013	2013	2013	2014	2014	2014	2015
Referral Criteria
general	consider individual preferences					▪				▪
	consider individual comorbidities			▪						▪
	cooperation or multidisciplinary care	▪			i	▪			▪	▪
	routine follow-up after referral by patient’s GP					▪				▪
nephrologist	GFR < 60 ml/min/1,73m²
	GFR < 45 ml/min/1,73m²	i		▪
	GFR < 30 ml/min/1,73m²	▪			▪	▪	▪	▪	▪	▪
	ACR > 30 mg/mmol	▪*			▪		▪			+ hematuria
	ACR ≥70 mg/mmol			▪						i#
	proteinuria > 3500 mg/day								▪
	hematuria				i	▪*
	urinary cell casts						▪
	constitutional symptoms						▪
	CKD progression	▪		▪	▪	▪	▪		▪	▪
	poorly controlled hypertension				▪	▪	▪			▪
	electrolyte disturbance			i	▪		▪		▪
	anemia			i				▪	▪
	metabolic complications			i					▪
	complications			i				i
	nephrolythiasis				▪				▪
	suspected renal artery stenosis	▪								▪
	genetic etiology of CKD				▪		▪			▪
	rare etiology of CKD									▪
	etiology requiring specialist care								▪
	unclear etiology						i	i	▪
	1-year ESRD-risk of ≥10%				▪
	indication for dialysis or transplant				▪		▪			▪
urologist	renal outflow obstruction	▪								▪
diabetologist	diabetic nephropathy						▪			▪
dietician	eGFR< 60 ml/min/1,73m²			▪	i					i
inpatient treatment	complications									▪
	hypertensive crisis									▪
	unknown etiology									▪

▪ recommendation, i: when indicated *in combination with KDIGO stage A3, # unless caused by diabetes and properly treated
ACR albumin-creatinine-ratio, CKD chronic kidney disease, ERSD end stage renal disease, GFR glomerular filtration rate, GP general practitioner, HbA1c glycated hemoglobin
American College of Physicians (ACP), Belgisch Centrum voor Evidence Based Medicine (CEBAM), British Columbia Medical Association (BCMA), Department of Veteran’s Affairs (VA-DoD), Haute Autorité de Santé (HAS), Kidney Disease Improving Global Outcomes (KDIGO), Kidney Health Australia - Caring for Australasiansians with Renal Impairment (KHA-CARI), National Institute of Health and Care Excellence (NICE), University of Michigan Health System (UMHS)

ISSN: 1471-2369