KFRE Access Referral Timing 18 Percent — ESENeph MCQ

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ModerateChronic Kidney DiseaseKFRE Access Referral Timing 18 PercentESENeph

A 57-year-old man with CKD G3b (eGFR 38 mL/min/1.73m2) is found to have a cystatin C-estimated eGFR of 34 mL/min/1.73m2 (concordant). His uACR is 45 mg/mmol. He is on ramipril 10 mg and dapagliflozin 10 mg. His 5-year KFRE risk is 18%. When should he be referred for vascular access assessment?

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Correct answer: A — Only after dialysis modality has been chosen

The correct answer is A. A 5-year KFRE risk of 18% identifies increased risk of future kidney replacement therapy and supports specialist CKD follow-up, but it is not, by itself, an indication for vascular access assessment. Vascular access assessment is specifically haemodialysis access planning: it should follow shared decision-making about kidney replacement therapy modality and is appropriate for patients planning haemodialysis who are likely to start within about 12 months. If the patient chooses peritoneal dialysis, transplantation, or conservative kidney management, arteriovenous access assessment may be unnecessary. Therefore, access assessment should occur only after dialysis modality has been chosen, not simply because the 5-year KFRE is 18%, symptoms develop, or eGFR falls below a fixed threshold.

Reference: UK Kidney Association Clinical Practice Guideline: Vascular Access for Haemodialysis, 2023. https://www.ukkidney.org/health-professionals/guidelines/vascular-access-haemodialysis-0