Dual RAS Blockade Evidence Harm — ESENeph MCQ

Correct answer: E — Refer for vascular-access imaging and salvage before further cannulation

The best answer is “Refer for vascular-access imaging and salvage before further cannulation”. UKKA emphasizes clinical usability and timely evaluation of non-maturation; ultrasound thresholds support but do not replace access-team assessment and correction of remediable lesions. “Continue repeated cannulation because any thrill proves maturity” is less appropriate because clinical usability and flow are inadequate and further trauma can cause failure “Convert to a tunnelled catheter after multidisciplinary access review” is less appropriate because correctable stenosis may permit access salvage “Prescribe hand exercise alone despite established focal stenosis” is less appropriate because exercise does not correct a haemodynamically significant lesion “Wait six months because maturation cannot be assessed earlier” is less appropriate because delayed intervention reduces salvage opportunity

Reference: UK Kidney Association vascular access for haemodialysis guideline: https://www.ukkidney.org/health-professionals/guidelines/vascular-access-haemodialysis-0