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Advanced CKD planning — ESENeph MCQ

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EasyChronic Kidney DiseaseAdvanced CKD planningESENeph

A 63-year-old woman with CKD G4 asks when dialysis education should begin. eGFR has fallen from 24 to 17 mL/min/1.73 m² over 12 months and ACR is 96 mg/mmol. She has pruritus and declining appetite but remains independent. What is the most appropriate management?

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Correct answer: A — Refer to a low-clearance service for modality education and access planning

Progressive CKD G4-G5 with symptoms should trigger low-clearance pathway referral for shared decision-making, transplant assessment where suitable, and dialysis access planning. Waiting until eGFR is extremely low risks unplanned dialysis starts. A temporary catheter is inappropriate without urgent dialysis indications. The pearl is that RRT preparation is a longitudinal process involving education, access, transplantation and conservative-care discussions.

Reference: NICE NG107; NICE NG203