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Table 7 Recommendation summary - referral criteria

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

  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         
  1. ▪ recommendation, i: when indicated *in combination with KDIGO stage A3, # unless caused by diabetes and properly treated
  2. ACR albumin-creatinine-ratio, CKD chronic kidney disease, ERSD end stage renal disease, GFR glomerular filtration rate, GP general practitioner, HbA1c glycated hemoglobin
  3. 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)