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BMI Transplant Listing Rationale — ESENeph MCQ

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HardTransplantationBMI Transplant Listing RationaleESENeph

A frail patient with CKD develops dizziness and standing systolic pressure 92 mmHg while treatment is being intensified toward a standardized systolic target below 120 mmHg. What is the best principle?

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Correct answer: B — Individualize treatment for symptomatic orthostatic hypotension

The best answer is “Individualize treatment for symptomatic orthostatic hypotension”. KDIGO’s lower standardized systolic target is conditional on tolerability, and symptomatic orthostatic hypotension warrants individualized treatment rather than mechanical pursuit of a number. “Continue intensification toward the seated systolic target” disregards treatment harm. “Add a diuretic after confirming adequate volume status” may worsen orthostasis. “Interpret the standing pressure as uncontrolled hypertension” reverses the meaning of a low standing pressure. “Continue the seated target during symptomatic orthostatic hypotension” neglects clinically important intolerance.

Reference: KDIGO 2021 blood-pressure guideline in CKD: https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2021-BP-GL.pdf