skip to main content

Refractory Fluid Overload Dialysis Indication — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModerateChronic Kidney DiseaseRefractory Fluid Overload Dialysis IndicationESENeph

A 50-year-old woman with CKD G4 (eGFR 18 mL/min/1.73m2) develops worsening peripheral oedema and dyspnoea. She is on Furosemide 160 mg BD and Metolazone 2.5 mg on alternate days. Her weight has increased by 4 kg. Urine output has dropped to 400 mL/day. Her symptoms are refractory to further diuretic escalation. What does this indicate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — This likely indicates the need for renal replacement therapy initiation for volume management

Refractory fluid overload despite maximum medical therapy (high-dose loop diuretic plus sequential nephron blockade with Metolazone) in advanced CKD is an indication for dialysis initiation. NICE NG107 includes fluid overload unresponsive to medical management as an indication for RRT. Ultrafiltration via haemodialysis or peritoneal dialysis can effectively manage volume. This aligns with the IDEAL trial approach of symptom-driven dialysis initiation rather than eGFR thresholds.

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