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Dialysis planning — ABIM Board MCQ

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ModerateNephrologyDialysis planningABIM Board

A 67-year-old woman has progressive stage 5 chronic kidney disease. Her eGFR has declined from 18 to 12 mL/min/1.73 m² during the past 6 months. She has received education about kidney replacement options and has selected in-center hemodialysis. She is expected to require dialysis within the next year but currently has no refractory volume overload, hyperkalemia, metabolic acidosis, or uremic manifestations requiring urgent initiation. She has no dialysis access. Which of the following is the most appropriate next step?

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Correct answer: C — Refer now for vascular mapping and arteriovenous fistula evaluation and planning

The correct answer is C. This patient has progressive stage 5 CKD, has selected hemodialysis, and will likely require it within the next year, but she has no current indication for urgent dialysis. She should therefore undergo timely vascular mapping and individualized evaluation for arteriovenous fistula creation. A fistula requires months to mature and should ideally be functional when hemodialysis begins. A tunneled catheter is not preferred as planned long-term access because of infection and other catheter-related risks; it is generally reserved for patients who must begin hemodialysis before permanent access is usable. Delaying referral risks an emergency catheter start. Peritoneal access conflicts with her informed modality choice and requires education and training. Continuing follow-up without access preparation is inappropriate.

Reference: National Institute of Diabetes and Digestive and Kidney Diseases. Prepare for Kidney Replacement Therapy, section “Prepare for Kidney Replacement Therapy Early.” Checked August 9, 2026. https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/kidney-disease/identify-manage-patients/manage-ckd/prepare-kidney-replacement-therapy