Stage III CKD – when to refer

I have written about this in the past.  This new blog (at least to me) addresses the issue from a nephrology perspective – Should all Stage III CKD patients see a Nephrologitis?  What about "Stage IIIb?"

But what about a new class? How about Stage 3b’s? This would comprise a subsegement of Stage 3 CKD patients at greater risk for progression of CKD. They would have creatinine clearance of 30-45 ml/min and/ or comorbid conditions such as diabetes, proteinuria >0.5-1 gram/d, suboptimal blood pressure control, or secondary hyperparathyroidism… I think this group of higher risk Stage 3 CKD patients would the most realistic group to target.

Anyway, I believe (and there is evidence to support) that there is value added in having a nephrologist as part of the TEAM in caring for a patient with CKD. Admittedly, there may in fact be a bit less value added in early stage 3 CKD (Stage 3a’s). I think as a community later stage 3 or "CKD 3b" may be the best target.

In Alabama we have difficulty getting most 3a’s seen – just a numbers problem.  I encourage the 3b strategy myself.

As I look at the data, the problems really do occur in 3b rather than 3a.