Guidelines for Care of Chronic Kidney Disease Patients

[traumaRUs, MSN, APRN]

New article out recently in NP magazine highlights care of the CKD population - a population which is growing. Here are the guidelines of when to refer to nephrology:

The KDIGO guideline recommends referral to a nephrologist when there is a decrease in GFR, progression of CKD, when the GFR decreases to less than 30 mL/min/1.73 m², and/or significant albuminuria.⁶ The NKF-KDOQI work group stated that all patients with nephrotic range proteinuria (UACR greater than 300 mg/g) should be seen by a nephrologist, as should those whose albuminuria is not improved despite addition of an ACEI or ARB or when the etiology is unclear.⁷

The presence of hereditary kidney disease, nephrolithiasis, chronic abnormal serum potassium, unexplained hematuria, and refractory hypertension in patients with CKD requires referral to a nephrologist.⁶Additional considerations for referral include secondary hyperparathyroidism, noniron deficiency anemia, and chronic anion gap acidosis.⁸

If available, care in a multidisciplinary team setting for those with advanced CKD is suggested in the KDIGO guideline.^6,24 There are several recommendations for the multidisciplinary team, including the ability to counsel on available renal replacement therapy options as well as transplant and vascular surgery options.⁶ Two studies on the effects of initiating multidisciplinary teams caring for pediatric patients with CKD found reduced kidney deterioration, improved hemoglobin levels, and improvement in some aspect of bone mineral metabolism.^25,26