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Dialysis Initiation — ESENeph MCQ

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ModerateChronic Kidney DiseaseDialysis InitiationESENeph

A 50-year-old man with stage 4 CKD (eGFR 18 mL/min/1.73m2) develops pruritus, fatigue, and nausea. His urea is 42 mmol/L and creatinine is 580 umol/L. He asks about the benefits of starting dialysis now versus waiting. Based on the IDEAL trial, when should dialysis be initiated?

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Correct answer: C — When symptoms develop or complications arise, not based on eGFR alone

The IDEAL trial (Cooper et al, NEJM 2010) demonstrated no survival benefit from early initiation of dialysis (eGFR 10-14) compared to late (eGFR 5-7). Current practice and NICE NG107 recommend starting dialysis based on symptoms (uraemic symptoms, fluid overload, hyperkalaemia unresponsive to medical management) rather than eGFR thresholds alone. This patient has uraemic symptoms and should be offered dialysis start.

Reference: Cooper et al 2010 – IDEAL Trial, NEJM; NICE NG107 2018 – RRT