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Conservative Management Flexibility — ESENeph MCQ

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ModerateChronic Kidney DiseaseConservative Management FlexibilityESENeph

A 60-year-old woman with CKD G5 has opted for conservative (non-dialytic) management. Her eGFR is 7 mL/min/1.73m2. She develops intractable pruritus and increasing oedema. Despite furosemide 250 mg daily, fluid overload is worsening. What option should be discussed?

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Correct answer: A — Time-limited trial of dialysis can be offered even in conservative pathway patients

Conservative kidney management does not preclude future dialysis if the patient's goals or circumstances change. NICE NG107 and UKKA conservative management guidelines emphasise ongoing shared decision-making. If symptoms become intractable and impact quality of life, a time-limited trial of dialysis can be offered. This respects patient autonomy while acknowledging that preferences may evolve as symptoms progress. Symptom burden should drive the conversation, not rigid pathway adherence.

Reference: NICE NG107 2018 – RRT and Conservative Management; UKKA 2021 – Conservative Management