When should patients with kidney disease be referred to a nephrologist?
CKD related complications and risk of development of kidney failure are highest among patients with CKD Stages 4 and 5. Late referral to nephrologists prior to dialysis initiation (GFR less than 15 milliliters per minute per 1.73 m2) is associated with a higher rate of morbidity and mortality.22 Patients with GFR estimates less than 30 milliliters per minute per 1.73 m2 should be referred to a nephrologist for co-management if they have not been referred earlier. Some of the many other reasons to refer to a nephrologist are listed in Table 6.
