Dear



Date ___ /___ / ___

Dear _________________________,

I was pleased to see your patient, ______________________, in my office on ___ /___ / ___ for evaluation of chronic kidney disease (CKD). Please find enclosed copies of studies performed in the course of this evaluation.

Your patient has diabetic/non-diabetic CKD, Stage 4/5 (eGFR __mL/min/1.73m²), associated with ____ ______(glomerular, vascular, tubulo-interstitial, or cystic disease - e.g. with biopsy-proven diabetic glomerulosclerosis). The major issues and goals to be addressed at this stage are: establishing the cause of the CKD; optimizing BP, lipid, and diabetes management; evaluation and treatment of anemia, calcium, phosphorus, and metabolic derangements; avoidance of nephrotoxic agents; attention to nutrition; ongoing review of medications/doses that may need adjustment in advanced CKD; education about renal replacement therapy options; and referral for vascular access when appropriate.

As a nephrologist who believes in the value of co-management of CKD patients, I am pleased to work closely with you to help manage your patient in a manner that is satisfactory to her/him and to you. I propose that we craft the co-management plan together based on your preferences, and that I will keep you up-to-date in terms of data sharing, communication of changes in medications, and instructions given to your patient. I will follow this letter with a phone call to discuss division of responsibilities so that we can agree on how best to coordinate this care for your patient.

I suggest that I focus my attention on managing renal-related bone disease, abnormalities of calcium, phosphorus, acidosis, vitamin D and PTH, renal-related anemia, and ongoing review of medications/doses that may need adjustment in advanced CKD. I will also arrange for nutritional counseling, education on modalities of renal replacement therapy, and referral for vascular access at an appropriate time. My goal is to assist you in management of your patient’s CKD and related complications. I anticipate that over the next year, I will need to see your patient about every 3 months. I will provide a letter (or other form of communication) summarizing each office visit. Currently of concern is (for example: Your patient has elevated phosphorus level (5.2) and I have recommended low phosphorus diet ( ................
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