Guide for Aviation Medical Examiners

AASI for Chronic Kidney Disease (CKD)

AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.

If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.

Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

  • An Authorization granted by the FAA;
  • A current status report from the treating physician detailing:
    • How long the condition has been stable and asymptomatic;
    • If there has been any significant change in eGFR or renal function;
    • Any interval development of other complications or abnormal physical exam findings (such as diabetes, uncontrolled HTN, or clinically significant proteinuria);
    • Most recent lab results including eGFR, creatinine, hemoglobin, hematocrit and urine albumin or ACR;
    • The name and dosage of medication(s) and presence or absence of any side effects; and
    • Statement from the treating physician if there is any evidence of cardiovascular disease.

The Examiner must defer to the AMCD or Region if:

  • The condition is no longer stable (per the treating physician note);
  • Dialysis has been started or transplant has occurred;
  • The airman is taking a medication that is not acceptable (See Pharmaceuticals - Antihypertensive) or has aeromedically significant side effects from the medication;
  • Anemia with hemoglobin less than 10 gm/dL or hematocrit less than 30% is present; or
  • The eGFR is 29 or less; (if this occurs, the airman will need to submit additional testing to show stability [such as inulin clearance testing, creatinine clearance testing, or a 24-hour urine creatinine result] and the nephrologist's clinical interpretation of results, prognosis, and plan for follow up).


Last updated: Thursday, March 9, 2023