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Chronic Kidney Disease (CKD)


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 (eg renal bone disease, acidosis, hyperkalaemia)
      • symptoms of CKD (eg 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 > 350g/mol)

    NB: 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 30-300mg/mmol OR PCR 60-300g/mol)
    • CKD with uncontrolled hypertension that are not achieving blood pressure target
    • CKD without clear diagnosis

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)

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 & ELFT results
  • Serial urea, creatinine & 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 renal 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 or macroalbuminurua present, include ANCA, ANA, ENA & anti DNA Abs, 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

Last updated: 13 June 2023