Chronic Kidney Disease (CKD)

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Severe acute electrolyte disturbance for example:
      • hyperkalaemia with K+ > 6.5mmol/L OR > 6.0mmol/L with ECG changes
      • hypokalaemia with K+ < 2.5mmol/L OR < 3.0mmol/L with symptoms
      • severe metabolic acidosis (HCO3 < 15mmol/L)
    • Severe hypertension especially when accompanied with declining kidney function
    • Patients with severe uraemic symptoms or signs
    • Evidence of acute fluid overload or heart failure in a patient with known CKD
    • Kidney transplant recipients with acute intercurrent illness
    • Peritoneal or haemodialysis patients with acute issues or problems with dialysis access (e.g. vascular access issues or peritoneal dialysis catheter issues)
    • Peritoneal dialysis patients with suspected peritonitis (abdominal pain, cloudy dialysis fluid)

    Note: If there is any uncertainty regarding the urgency of referral for an unwell patient, please contact your local Kidney Medicine service for guidance.

  • Note: At the level of nephrotic range proteinuria, albumin accounts for 60-70% of total urinary protein. Within the CPC, ACR > 220mg/mmol OR PCR > 300g/mol has been used for simplicity and ease of application.

    • Before waiting 3 months to refer, it is important to establish that there is no evidence of acute kidney injury

    In the absence of other referral indicators, referral may not be necessary if following conditions are met:

    • Stable eGFR ≥ 30 mL/min/1.73m2
    • Urine ACR < 30 mg/mmol (with no haematuria)
    • Controlled blood pressure

    Referral decisions should be individualised, with less stringent criteria for younger patients. In cases where it may not be necessary for the patient with CKD to be seen by a specialist, management issues can be discussed via GPSR Request for advice.

    Clinician resources

    Patient resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Stage 5 CKD (eGFR < 15) that does not require referral to emergency
  • Stage 4 CKD (eGFR 15 – 29) with any of the following:
    • severe complications (e.g. kidney bone disease, acidosis, hyperkalaemia)
    • symptoms of CKD (e.g. fatigue, restless legs, itch, weight loss, severe anaemia, mild uremic symptoms)
    • multiple contributing comorbidities
    • rapid deterioration
  • Known CKD with severe anaemia (Hb <80g/L)
  • Persistent nephrotic range proteinuria* (urine ACR > 220mg/mmol OR PCR > 300mg/mmol)

Note: eGFR units: mL/min/1.73m2
Category 2
(appointment within 90 calendar days)
  • Stage 4 CKD (eGFR 15 – 29) that do not meet Category 1 criteria
  • Stage 3a or b CKD with progressive deterioration in eGFR despite treatment (eg deterioration in eGFR >15mL/min/1.73m2 or > 25% over 12 months)
  • CKD with resistant hypertension despite at least three antihypertensive agents including at least one diuretic
Category 3
(appointment within 365 calendar days)
  • Chronic anaemia (Hb 80-100g/L) with CKD Stage 3a or b where other causes have been excluded
  • Persistent sub-nephrotic range macroalbuminuria (urine ACR 30-220mg/mmol OR PCR 60-300mg/mmol)
  • CKD with uncontrolled hypertension that are not achieving blood pressure target
  • CKD without clear diagnosis

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention not otherwise accessible to the patient
  • For advice regarding management
  • To engage in an ongoing shared care approach between primary and secondary care
  • Reassurance for GP/second opinion
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Presence of comorbid conditions such as hypertension, diabetes or vascular disease
  • List of medications
  • FBC and ELFT results
  • Serial urea, creatinine and eGFR results demonstrating abnormal eGFR over at least 3 months
  • Urine albumin creatinine ratio (ACR) or urine protein creatinine ratio (PCR) (ideally early morning sample but a random sample is acceptable)
  • Urine midstream M/C/S (including testing for red cell morphology and casts preferable)
  • Recent BP results
  • Ultrasound (kidney, ureters & bladder) or alternative kidney imaging results

3. Additional referral information Useful for processing the referral

  • Timeline of symptoms
  • Ethnicity (Aboriginal and Torres Strait Islander population especially at risk)
  • Iron studies, B12 and folate (essential if referring for anaemia)
  • Other supportive investigative tests indicated including:
    • If haematuria and/or albuminuria are present and a glomerulonephritis is suspected, consider ANCA, ANA, ENA & anti-DNA antibodies, C3/C4, and hepatitis B/C serology
    • If myeloma suspected, include paraprotein testing (especially if proteinuria) e.g. FLC, SEPP, urine BJP, PTH
  • Family history of kidney disease
  • Kidney biopsy report (if available)

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 12 December 2025

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