American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with stage G4 or G5 chronic kidney disease, referral for transplant evaluation is indicated when eGFR drops below which threshold?

1. 15 mL/min/1.73 m2

2. 25 mL/min/1.73 m2

3. 20 mL/min/1.73 m2

4. 10 mL/min/1.73 m2

The correct answer is: 20 mL/min/1.73 m2

In patients with stage G4 or G5 chronic kidney disease (CKD), referral for transplant evaluation is typically indicated when the estimated glomerular filtration rate (eGFR) falls below 20 mL/min/1.73 m². This threshold is important because it marks a point at which patients are considered to have advanced kidney failure and are at increased risk for complications associated with decreased kidney function. At this level of eGFR, patients often experience significant symptoms and may require interventions such as dialysis or a transplant. Evaluating candidates for kidney transplantation earlier, preferably before reaching ESRD (end-stage renal disease), can increase the likelihood of a successful outcome. Identifying patients who are eligible for transplantation while there is still some kidney function helps ensure that they can be effectively managed and that they remain in better overall health for surgical procedures. Referral at this level allows for the comprehensive workup needed to assess suitability for transplant, including evaluation of other comorbid conditions, psychosocial factors, and the presence of a suitable donor. Hence, it is crucial to refer patients with CKD for evaluation as their renal function approaches this critical threshold.