Primary Healthcare Resources

To our primary healthcare provider colleagues:
 
Early identification and care of individuals with chronic kidney disease (CKD) will delay progression and optimize management of co-morbidities, such as cardiovascular disease. Research has revealed that interprofessional CKD care results in: 
  • Increased probability of starting dialysis on a home-based therapy. 
  • Increased chance of starting dialysis with a fistula, if hemodialysis is selected. 
  • Considerably less urgent dialysis starts.
  • Less hospital days in the first months of dialysis.
  • Better survival once on dialysis.
(Curtis, BM et al, 2005) (Levin, A, 1997) (Goldstein, M et al, 2004)
 
Identification, Management and Referral Algorithm
To support Primary Health Care, a decision support tool has been developed to help identify patients at risk of developing CKD, how to investigate CKD,  which tests to order and how to assess the results. Information on the medical management of CKD patients is included as well as general information regarding the definition and criteria for CKD. Identification, Management and Referral Algorithm.
 
Referral to Nephrology/CKD care
There are three Nephrology referral sites in Nova Scotia: QEII, Central Zone, Halifax; Cape Breton Regional Hospital, Eastern Zone, Sydney and Yarmouth Regional Hospital, Western Zone, Yarmouth. All three programs use a standardized Nephrology referral process, triage criteria and referral form (.pdf). Sending a request to a specific nephrologist is not needed unless you have spoken to a specific nephrologist, the patient has been seen by a specified nephrologist in the past or you have a preference for a specific nephrologist. 
 
Determination of urgency is based on the accompanying information with the consult; Emergent <1 day, Urgent (Priority 1) <7 days, Semi-Urgent (Priority 2) <30 days, Elective (Priority 3) <90 days, Elective (Priority 4) 180 days, Elective (Priority 5) 365 days. Additional detail is contained in the Referral Form .
Referral Form for Nephrology Consult  
 
 
Acute Renal Failure
 
In some cases, such as acute renal failure, including rapidly rising Creatinine, contacting the nephrologist on call may be more appropriate. Contact numbers for each Renal Program:
  • QEII, Central Zone Nephrology Program, Halifax through the switchboard at 902-473-2220. 
  • Cape Breton Regional Hospital, Eastern Zone Nephrology Program, Sydney through the switchboard at 902-567-8000.                                             
  • Yarmouth Reginal Hospital, Western Zone Nephrology Program, Yarmouth through the switchboard at 902-742-3541.   
 
Additional Resources:
  1. The Chronic Kidney Disease Clinical Pathway, developed by the University of Calgary is an online tool for primary care providers to aid in the diagnosis, medical management, and referral of adults with CKD and is available on line. www.ckdpathway.ca
  2. The KidneyWise Clinical Toolkit, developed by the Ontario Renal Network (ORN), assists primary care providers with the identification, detection, and management of chronic kidney disease (CKD). The toolkit is available online and you can download an IPhone and Android app. www.kidneywise.ca .
  3. • Please note that the Nephrology referral guidance in these tools differs from the referral guidance. Please follow the Nova Scotia referral recommendations above:  Chronic Kidney Disease (CKD) in Primary Care- Identification, Management and Referral Algorithm. 
  4. The Kidney Failure Risk Equation –Calculator to estimate the risk of progression to end-stage renal disease in CKD patients using age, sex, eGFR and proteinuria for potential patients with CKD Stage 3 to 5.
  5. Please refer to the Canadian Society of Nephrology website for additional information on detection, monitoring and referral of patients with chronic kidney disease.  (Insert link in society name. Link:  http://www.csnscn.ca/education/educational-resources
  6. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.