Pathways and Stages Kidney disease pathway hematuria pathway diabetes pathway non-diabetic MRP CKD stages referral sheet
    Disclaimer: The information and data in this document ("Information") is based on scientific evidence current as of the date issued and is subject to change without notice. The Information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Any person consulting or applying the Information is expected to use independent medical judgment and expertise in the context of individual clinical circumstances. Winnipeg Regional Health Authority and the Manitoba Renal Program make no representation or guarantees of any kind whatsoever regarding the content or use or application of the Information and specifically disclaim any responsibility for its application or use in any way.

Explaining eGFR and the Risk Equation

  • Automatic estimated Glomerular Filtration Rate (eGFR) reporting was introduced in Manitoba in 2010 per Canadian Society of Nephrology guidelines to assist practitioners in the early identification of chronic kidney disease (CKD).  
  • eGFR <30 ml/min adequately predicts increased patient risk RISK for End Stage Renal Disease (ESRD). However, it is recognized that in patients with milder degrees of CKD, with eGFR. >30 ml/min, it alone is often insufficient to predict the RISK of progression to ESRD.
  • Newer recommendations from the Kidney Dialysis Improving Global Outcomes (KDIGO) group in 2012 endorse predicting CKD progression risk to guide decisions for testing and treatment of CKD complications.

  • The Manitoba Renal Program now uses a calculator* to better identify patients at increased RISK for progression to End Stage Renal Disease, especially in those with eGFRs from 30-60 ml/min. This calculator requires the following information:

    • Age and Sex
    • Creatinine/estimated GFR (eGFR) – preferably two values
    • Urine albumin: creatinine ratio
  • When the MRP triages patients for timely Nephrology consultation we require that you provide the  above information, in addition to your patient’s past medical history, medications list, and urinalysis, which aid the triaging process and to appropriately risk stratify each patient.

  • Please use the Manitoba Renal Program’s Referral Pathway and the following link to the Kidney Failure Risk Equation (KFRE) for additional information,  and  to help you decide whether your patient may require a referral. Do not hesitate to contact us with questions at any time.

  • Using the risk prediction calculator, we define a patient’s overall risk for developing End Stage Renal Disease over five years. Those at intermediate or high risk are identified and assessed accordingly. Those that have a <3% predicted risk of developing ESRD over five years are felt to be low risk and as a result, nephrology referral may currently not be indicated.
  • This can be illustrated by the following example:
    • Two female patients 75 years old each with eGFR of 45 ml/min and a history of hypertension. A urine ACR for patient A is 10 mg/mmol and patient B is 100 mg/mmol. Patient A is found to be at 1.9% and patient B at 4.2% risk of progression to ESRD in 5 years.
    • Therefore, the consult on patient A would be returned as low risk with appropriate guidelines and patient B would be booked for routine assessment by nephrology.

* Tangri N, Stevens LA, Griffith J, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011;305(15). DOI:10.001/jama.2011.451