Referring Patients for End-Stage Renal Disease (ESRD)

By: AvMed News AvMed News

If your patient is exhibiting symptoms of kidney disease, coordinating care with a specialist can help improve health outcomes significantly. This is especially true when dealing with end-stage renal disease (ESRD), otherwise known as kidney failure.

One way to determine whether a referral is warranted is the patient’s glomerular filtration rate (GFR), a measure of how well the kidneys are working. The lower the GFR, the more advanced the renal disease.

Once the GFR reaches a level of 30-40 ml/minute, a nephrologist should be consulted. At this point, it’s not uncommon for patients to exhibit resistance to a referral. They may be afraid of dialysis, be in denial about their diagnosis or want to stay under your care. It’s important to remind them that the earlier they seek help, the less likely they’ll have complications.

When dealing with ESRD in patients, a timely referral is crucial. A referral is considered late if it’s within one to six months of requiring renal replacement. Patients who are referred late are likelier to have complications like uncontrolled hypertension and anemia.

AvMed uses a multidisciplinary approach when dealing with ESRD. This team approach can include the internist, the nephrologist, the vascular surgeon, a dietitian and other crucial health care members. By using this type of approach, we’ve reduced emergency dialysis initiation, prolonged hospitalization and decreased the incident of dialysis catheters.

To further educate our Providers on ESRD, we’ve put together a short video that you can see below. This video, narrated by Marcus Esquenazi, MD, provides a more in-depth look at nephrologist referrals.

You can also access the video on our Provider Education page, which offers additional physician resources.