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Advance Care Planning Conservative Management — ESENeph MCQ

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EasyChronic Kidney DiseaseAdvance Care Planning Conservative ManagementESENeph

A 73-year-old man with CKD G5 (eGFR 9 mL/min/1.73m2) and multiple comorbidities (heart failure, peripheral vascular disease, dementia) chooses conservative kidney management after shared decision-making. Which of the following is MOST important in his ongoing care?

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Correct answer: C — Advance care planning including preferred place of death

For patients choosing conservative (non-dialytic) kidney management, advance care planning is the cornerstone of care. This includes discussing goals, values, preferred place of death, resuscitation decisions, and symptom management priorities. NICE CKD guidance and KDIGO 2024 emphasise that conservative management is a valid choice, particularly for patients with significant comorbidity burden where dialysis may not confer survival or quality-of-life benefit. ESA targets in conservative care are symptom-driven rather than targeting specific Hb levels. Fistula formation is inappropriate if dialysis is not planned. Very low protein diets risk malnutrition in this frail population.

Reference: NICE 2021 – NG203 RRT and Conservative Management; KDIGO 2024 – CKD Guideline; UKKA 2021 – Conservative Kidney Management