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Responsive vs Refractory Fluid Overload CKD — ESENeph MCQ

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ModerateChronic Kidney DiseaseResponsive vs Refractory Fluid Overload CKDESENeph

A 55-year-old man with CKD G4 develops acute pulmonary oedema. He is not on dialysis. His eGFR is 16 mL/min/1.73m2. After IV Furosemide 250 mg, he produces 800 mL urine over 2 hours and symptoms improve. Does this represent an indication for dialysis?

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Correct answer: C — Not if the fluid overload responds to medical therapy; dialysis is indicated when fluid overload is REFRACTORY to maximum medical management; this episode responded to diuretics

NICE NG107 and KDIGO guidelines state that dialysis should be initiated for refractory fluid overload (not responding to maximum medical therapy). This patient's pulmonary oedema responded to high-dose IV Furosemide, suggesting medical management is still effective. However, this episode should trigger: reassessment of oral diuretic regimen, dietary sodium and fluid restriction counselling, RRT planning (fistula creation if not done), and discussion about dialysis timing. Recurrent fluid overload despite optimised medical therapy would constitute an indication for dialysis initiation.

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