American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of management options should patients with an eGFR of less than 30 mL/min/1.73 m2 be informed about?

1. Clinical trial options only

2. Only medication management

3. Strict diet management only

4. Dialysis, transplantation, and non-dialytic management

The correct answer is: Dialysis, transplantation, and non-dialytic management

Patients with an estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m² are considered to be in advanced stages of chronic kidney disease (CKD), specifically stage 4 or 5. At this level of renal function, managing the patient's care involves several critical options. Dialysis and transplantation are important forms of renal replacement therapy. Dialysis can be necessary when kidney function declines to the point where waste products and fluids start to build up in the body, leading to serious health issues. Patients should be educated about both hemodialysis and peritoneal dialysis, including the logistics, benefits, and potential complications of each type. Moreover, kidney transplantation is another viable option for patients with end-stage renal disease, and candidates can be informed of what it entails, including eligibility criteria, the evaluation process, and the possibility of waiting for a suitable donor organ. In addition to these more intensive treatments, patients with low eGFR should also learn about non-dialytic management options. This can include conservative management strategies that focus on symptom control, quality of life improvements, and potentially delaying the progression to dialysis or transplantation. This may involve careful management of dietary intake, meticulous monitoring of blood pressure