Table 1.

Who to test for chronic kidney disease and who to refer for specialist assessment

Who to test for CKD (using GFR and ACR)Who to refer for specialist assessment
Diabetes mellitusGFR <30 mL/min/1.73 m2 with or without diabetes
HypertensionACR ≥70 mg/mmol unless caused by diabetes and appropriately treated
Acute kidney injuryACR ≥30 mg/mmol together with haematuria
Cardiovascular diseaseSustained decrease in GFR ≥25% and a change in GFR category or sustained decrease in GFR ≥15 mL/min/1.73 m2 or more within 12 months
Structural renal tract diseasePoorly controlled hypertension despite at least four agents at therapeutic doses
Multisystem diseases with potential kidney involvement eg SLEKnown or suspected rare or genetic cause of CKD
Family history of end-stage kidney disease or hereditary kidney diseaseSuspected renal artery stenosis
Opportunistic detection of haematuria
  • eGFR should also be monitored at least annually in people prescribed drugs known to be nephrotoxic, such as calcineurin inhibitors (for example, cyclosporin or tacrolimus), lithium and non-steroidal anti-inflammatory drugs. ACR = albumin to creatinine ratio; CKD = chronic kidney disease; GFR = glomerular filtration rate; SLE = systemic lupus erythematosus.