Clinical Highlight: National Kidney Month: When Should You Refer CKD to Nephrology? Key Pearls for APPs

"My patient's renal function keeps deteriorating, and I'm unsure how to manage it. When should I refer the patient to nephrology?"

by: Lisa Mathis MSN, FNP-BC

Advanced Practice Clinicians frequently encounter patients with declining renal function in primary care. Early recognition and management of chronic kidney disease (CKD) can significantly slow disease progression and reduce complications such as cardiovascular disease, anemia, and electrolyte disturbances.

A few clinical pearls to keep in mind:

• CKD is defined by stages G1 to G5 with assigned albuminuria as secondar classification A1, A1, and A3.
• For all patients with hypertension, diabetes, cardiovascular disease or other risk factors, screen annually with eGFR and urine albumin-to-creatinine ratio (UACR).
• Evidence-based therapies—including ACE inhibitors/ARBs, SGLT-2 inhibitors, GLP-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists—can help slow CKD progression and reduce cardiovascular risk.

Referral to nephrology is generally recommended when:

• Rapid decline in kidney function
• Persistent significant albuminuria
• Resistant hypertension, electrolyte abnormalities, or uncertain etiology of kidney disease.

Early referral can improve outcomes, optimize medication strategies, and help prepare patients for advanced kidney care when necessary.

NPACE has more information on CKD management! Read on for information on NPACE CKD education.

Featured Course - CKD Management: Latest and Greatest in Kidney Care with Dr. Kevin Tucker

This session reviews current pharmacologic strategies to slow CKD progression, including renin-angiotensin system blockade, SGLT-2 inhibitors, GLP-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists. The course also addresses common CKD complications such as hyperkalemia, pruritus, and anemia, along with the critical relationship between chronic kidney disease and cardiovascular disease, the leading cause of death in this population.

Explore this course and many more in the NPACE Learning Center. (LINK TO COURSE)

References:

Centers for Disease Control and Prevention. (2024). Chronic kidney disease in the United States, 2024. U.S. Department of Health and Human Services. Retrieved from https://www.cdc.gov/kidney-disease/

Kidney Disease: Improving Global Outcomes (KDIGO). (2024). CKD Evaluation and management. Retrieved from https://kdigo.org/guidelines/ckd-evaluation-and-management/

National Kidney Foundation. (2023). KDOQI clinical practice guideline for diabetes and CKD update. American Journal of Kidney Diseases, 82(3), S1–S127.