¹Possible indications for urology consultation: isolated or gross hematuria, renal masses or complex cysts, symptomatic or obstructing nephrolithiasis, hydronephrosis or bladder abnormalities, urinary symptoms.

Possible indications for nephrology consultation: eGFR < 30 mL/min/1.73 m², decline in eGFR > 5 mL/min/1.73 m² per year, non-DM with heavy proteinuria or hematuria, unclear cause of CKD, complications of CKD (anemia, acidosis, hyperphosphatemia, hyperparathyroidism, electrolyte abnormalities), DM with heavy proteinuria or hematuria, management of nephrolithiasis, ADPKD.

²Use serum creatinine-based eGFR for initial assessment. If eGFR < 60 mL/min/1.73 m², consider one time serum cystatin C-based eGFR to confirm diagnosis and refine staging of CKD.

¹Metformin: Reduce dose once eGFR < 45 mL/min/1.73 m². Discontinue if eGFR < 30 mL/min/1.73 m² or HD initiation.

²SGLT2-I: Do not start if eGFR < 30 mL/min/1.73 m². Discontinue with HD initiation.