Dietetics — Referral to a Renal Dietitian for Advanced Chronic Kidney Disease
A general dietitian refers a 62-year-old man with rapidly progressing CKD Stage 4 to a specialist renal dietitian. The case is complicated by simultaneous potassium, phosphate, and fluid restrictions conflicting with his prior cardiac diet. The proficient challenge is framing the clinical complexity accurately and asking a specific, actionable referral question.
Letter type
Referral
Write to
Nephrology Dietitian
Target length
200–230 words
The case notes
Patient: Mr George Sullivan, 62 years old; retired
Diagnosis: CKD Stage 4 (eGFR 18, down from 28 six months ago); hypertensive nephropathy; post-NSTEMI (2022) on dual antiplatelet therapy and statin
Biochemistry: Potassium 5.8 mmol/L (high); phosphate 1.62 mmol/L (high); albumin 38 g/L (borderline); eGFR 18 (rapidly declining)
Current diet: Following a general cardiac diet (high-potassium foods: bananas, tomatoes, oranges as 'heart healthy'); low sodium 1.5 g/day; protein intake estimated 1.2 g/kg/day (above CKD recommendation of 0.6–0.8 g/kg/day)
Conflict: Cardiac diet advice and renal dietary requirements conflict significantly — patient confused by contradictory guidance; reluctant to change diet he believes protects his heart
Fluid: Oedematous ankles; fluid restriction to 1.5 L/day recommended by nephrology
Reason for referral: General dietetics lacks specialist competence to manage simultaneous potassium, phosphate, protein, and fluid restrictions in advanced CKD; urgency given rapidly declining eGFR and hyperkalaemia risk
Task: Write a referral letter to the renal dietitian, Ms Priya Nair, explaining the clinical context and the specific question you need answered.
Writing task
Write a referral letter to the renal dietitian, Ms Priya Nair, explaining the clinical context and the specific question you need answered.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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The specific abnormal biochemistry: potassium 5.8 (high), phosphate 1.62 (high), eGFR 18 declining
These values define the urgency and the specific dietary restrictions required. A referral without the biochemistry does not allow the renal dietitian to assess whether the consultation is urgent — potassium 5.8 in advanced CKD is urgent.
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The cardiac-renal diet conflict and the patient's reluctance to change
This is the unique clinical complexity that makes a general dietitian refer to a specialist. The renal dietitian must know about the conflict before the appointment to prepare a unified approach.
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The specific referral question: rationalise the simultaneous restrictions given the conflicting cardiac diet
A referral letter without a specific question fails Genre & Style. The renal dietitian must know what decision is being delegated.
Leave out
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Full cardiac history and NSTEMI details
Context only — one clause: 'post-NSTEMI 2022 on dual antiplatelet therapy'. The NSTEMI workup and cardiology follow-up are not relevant to the dietary referral.
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A dietary prescription in the referral letter
The referral is to a specialist because general dietetics does not have the competence to make this prescription. Writing one in the referral contradicts the reason for referral.
Criterion in focus · Purpose
A referral from a generalist to a specialist must state clearly in the first or second sentence: what the problem is, why the referring clinician cannot manage it alone, and what the specialist is being asked to do. 'I am referring Mr Sullivan for specialist management of his simultaneous potassium, phosphate, and fluid restrictions given conflicting prior cardiac dietary guidance' is complete; 'I am referring Mr Sullivan to you for specialist renal dietary advice' is not.
Now write the letter — and find out what is blocking your Grade B
Write a 200–230 words referral letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.