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Surprise Question Prognosis Conservative Management — ESENeph MCQ

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EasyChronic Kidney DiseaseSurprise Question Prognosis Conservative ManagementESENeph

A 70-year-old man with ESKD has chosen conservative kidney management. He has eGFR 6 mL/min/1.73m2 and is experiencing fatigue, anorexia, and mild confusion. His family asks about his expected survival. What tool is recommended by NICE to estimate prognosis in patients choosing conservative management?

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Correct answer: B — Surprise question ('Would you be surprised if this patient died in the next year?')

The 'Surprise Question' ('Would you be surprised if this patient died in the next 6-12 months?') is a simple, validated prognostic tool recommended by NICE NG203 and the Gold Standards Framework for identifying patients who may benefit from advance care planning and palliative care. If the answer is 'No, I would not be surprised,' palliative care assessment and ACP discussions should be prioritised. While not a precise prognostic calculator, it has reasonable sensitivity for identifying patients in their last year of life. The KFRE predicts kidney failure risk, not overall survival. Charlson Comorbidity Index provides population-level risk but is less intuitive for clinical decision-making at the bedside.

Reference: NICE 2021 – NG203 CKD; Gold Standards Framework 2016; UKKA 2021 – Conservative Kidney Management