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Conservative management of end-stage kidney disease — SCE Geriatric Medicine MCQ

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HardPalliative careConservative management of end-stage kidney diseaseSCE Geriatric Medicine

A capacitous 90-year-old with eGFR 7 mL/min/1.73 m² has repeatedly declined dialysis. She now has uraemic pruritus, anorexia and fatigue but no emergency refractory hyperkalaemia or pulmonary oedema, and wishes to remain at home. Which plan best honours her decision?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Provide comprehensive conservative kidney care with anticipatory planning

Explanation lettering: D = shown as C · E = shown as D · C = shown as E

A conflicts with her capacitous, repeated refusal. B is correct: comprehensive conservative kidney management combines active symptom control, prognosis, advance care planning, carer support and coordination of preferred place of care. C fragments treatment from the decisions needed to avoid crisis care. D omits community coordination despite her home-care preference. E makes accepted symptom treatment contingent on repeatedly reopening a declined intervention.

Reference: NICE NG107: renal replacement therapy and conservative management: https://www.nice.org.uk/guidance/ng107