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Conservative kidney management — ESENeph MCQ

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ModerateChronic Kidney DiseaseConservative kidney managementESENeph

An 82-year-old man with CKD G5, severe frailty and advanced heart failure attends low-clearance clinic. eGFR is 9 mL/min/1.73 m², albumin is 31 g/L and he has mild anorexia but no refractory fluid overload. He says avoiding hospital visits matters more than survival extension. What is the most appropriate management?

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Correct answer: D — Shared decision-making about active supportive kidney care

For a frail patient with advanced CKD whose goals prioritise quality of life, active supportive kidney care is an appropriate pathway when chosen after informed shared decision-making. Dialysis should not be imposed purely because eGFR is low. Transplantation is not realistic in this scenario. The pearl is that conservative kidney management is active care, including symptom control, advance care planning and treatment of reversible problems.

Reference: NICE NG107; Renal Medicine 2022 Curriculum