Ask AI
Back Back
Nephrology HCP Roles in Interdisciplinary CKD Care
Nephrology HCPs in CKD Care: A Primary Care Colleague’s Perspective

Released: November 05, 2025

Chuck Vega
Chuck Vega, MD, FAAFP
Activity Information

Activity

Progress
1
Course Completed
Continue
Key Takeaways
  • Current KDIGO guidelines recommend referring patients with chronic kidney disease (CKD) to a nephrology specialist when 5-year kidney failure risk reaches 3% to 5%. However, patients with indications of rapidly progressing or severe disease (eg, rapidly progressing overt proteinuria, hematuria, symptoms of inflammation) should be referred right away.
  • Newer therapies—SGLT2 inhibitors, nonsteroidal MRAs, and GLP-1 receptor agonists—have augmented the CKD treatment landscape and offer increased potential to improve patient outcomes.
  • Clear and effective communication among multidisciplinary CKD care team members is essential for coordinating treatment approaches and ensuring patients’ health and safety.

For decades, renin–angiotensin system (RAS) inhibitors have been a foundational treatment for chronic kidney disease (CKD), and they remain a first-line intervention in CKD care. Over the past several years, however, more therapies to slow CKD have become available. Current Kidney Disease: Improving Global Outcomes (KDIGO) CKD guidelines recommend use of SGLT2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists (nsMRAs), and GLP-1 receptor agonists (GLP-1 RAs) to improve outcomes for patients with CKD. This is great progress, but it poses a challenge in determining which healthcare professional (HCP) should provide prescriptions for these agents. This is a particular issue because primary care HCPs are often the first to identify patients with CKD, and many patients with CKD are managed in primary care, in part because there are relatively few nephrologists in the US, with only 1 for every 2800 patients with moderate CKD. 

Timing of Nephrology Referral for CKD
Many patients are first referred to nephrology when they have advanced CKD and are close to needing dialysis. For nephrology HCPs, meeting a patient in the hospital when they are in need of emergent dialysis is not the best way to start a patient–provider relationship. The 2024 KDIGO CKD guidelines recommend referring patients to nephrology and incorporating multidisciplinary care when patients’ 5-year kidney failure risk is 3% to 5%, which corresponds approximately with the time patients progress to CKD stage G3. The KDIGO guidelines also recommend using validated risk equations, such as the Kidney Failure Risk Equation, to predict patients’ risk for kidney failure and guide timing for nephrology referrals. It is important, though, that patients with indications of serious disease, such as rapidly progressing CKD, accelerated development of overt proteinuria, hematuria, and/or other signs or symptoms of inflammation, are referred to nephrology right away. 

As suggested by KDIGO guidelines, referral to nephrology specialists is not essential for initiating certain CKD treatments, including RAS inhibitors or SGLT2 inhibitors. These agents can typically be started in the setting where patients receive routine care, such as primary care. However, in the context of more advanced CKD, nephrology HCPs have more expertise with interventions needed to slow disease progression and manage complications (eg, electrolyte abnormalities, anemia) that might occur. Nephrology specialists are critical for providing evidence-based, patient-centered care in advanced CKD.

Team-Based Multidisciplinary Care for CKD
Although referral to nephrology specialists is not required to start standard-of-care therapies, there may be situations in which a nephrology specialist is the HCP to begin standard treatments, such as when patients who are referred to nephrology are not on the appropriate treatment(s). Regardless of the specific situation, the right person to write the prescription is the HCP who recognizes the gap in care, whether it is a nephrology, cardiology, endocrinology, or primary care HCP, or even an emergency medicine/urgent care HCP who might see these patients if they develop hyperkalemia. The good thing about a team-based, multidisciplinary care approach is that patients can receive their optimized CKD treatment sooner.

All HCPs caring for patients with CKD should adjust their treatment as needed. They should not defer changes and say, “I am not a nephrology specialist, so I do not think I should prescribe anything. It is better if the patient just waits the 4 months until their next nephrology appointment.” That is too long of a wait because patients can lose significant kidney and physical function over that time.

To ensure that changes in care are not delayed or missed, a key component of comprehensive CKD care is communication among all HCPs who are seeing these patients. In particular, HCPs should communicate about what is and is not going well and also what has and has not worked in the past; a patient should not receive continued or repeated treatment with a therapy that they do not tolerate because of hypotension or electrolyte abnormalities. In addition, effective communication should not rely on patients relaying information from one HCP to another, as patients may not have sufficient health literacy to provide the information HCPs need. Therefore, it is incumbent on all HCPs to communicate clearly and effectively with one another. Although coordinated electronic health records can help with this effort, often a phone call or in-person conversation is needed to clear up a matter quickly. This communication can be incredibly important to patients’ health and safety. That is why it should include all HCPs involved in patients’ care, including nephrology, dialysis center, primary care, and cardiology HCPs, among others. Finally, when patients hear the same messages from different sources on their interdisciplinary care team, the message is reinforced, and the reinforcement can improve patients’ understanding of their disease and management approaches and potentially promote treatment adherence.

Your Thoughts
How often do you use a validated risk equation to determine if patients with CKD should be referred to a nephrology specialist? You can get involved in the conversation by answering the poll question and posting a comment below.

Continue

Poll

1.

How often do you use a validated risk equation to determine if patients with CKD should be referred to nephrology?

Submit