Advance Care Planning CKD — ESENeph MCQ

Correct answer: A — Begin shared planning now and revisit choices over time

The best answer is “Begin shared planning now and revisit choices over time”. NICE recommends early, repeated information and shared decision-making so access, transplantation and supportive-care plans can reflect prognosis and patient goals before kidney failure becomes urgent. “Begin modality planning when emergency dialysis becomes necessary” is less appropriate because late crisis planning prevents informed choice and timely access preparation “Discuss haemodialysis while deferring conservative-care information” is less appropriate because NICE includes transplantation, dialysis modalities and conservative management “Defer modality planning until eGFR falls below 5 mL/min/1.73m²” is less appropriate because planning is based on anticipated need and trajectory, not a single very low threshold “Ask primary care to select the kidney-replacement modality” is less appropriate because this is a multidisciplinary shared decision with the patient

Reference: NICE NG107: renal replacement therapy and conservative management: https://www.nice.org.uk/guidance/ng107/chapter/Recommendations