American Board of Internal Medicine (ABIM) Certification Practice Exam

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When should patients with an eGFR below which value be educated about treatment options for end-stage kidney disease (ESKD)?

40 mL/min/1.73 m2
30 mL/min/1.73 m2
25 mL/min/1.73 m2
15 mL/min/1.73 m2

The correct answer is: 30 mL/min/1.73 m2

Patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m² are at a critical point regarding their kidney function and are typically considered to have significantly impaired renal function. At this stage, it is essential to begin discussions about treatment options for end-stage kidney disease (ESKD), as patients may progress to requiring dialysis or transplantation. Educating patients when their eGFR drops below this threshold allows for proactive planning and management of their condition. This includes initiating discussions about lifestyle modifications, preparing for potential dialysis, discussing kidney transplant options, and addressing any associated complications of advanced chronic kidney disease. By starting these conversations at this level of eGFR, healthcare providers can help patients understand their conditions better and make informed decisions about their treatment options, enhancing patient autonomy and preparedness for managing their health as they transition towards ESKD.