A 63-Year-Old Woman with a Long History of Type 2

question 463

Multiple Choice

A 63-year-old woman with a long history of type 2 diabetes mellitus is being evaluated for a progressive decline in renal function.  She has no new complaints except for occasional tiredness and lower back pain.  Her other medical problems include hypertension, obesity, mild diabetic retinopathy, and peripheral neuropathy.  One year ago, she was evaluated for atypical chest pain and had a negative exercise stress test.  She is a lifetime non-smoker.  Her current medications include insulin, amlodipine, and low-dose aspirin.  She was treated with lisinopril, which has been stopped recently due to renal dysfunction and hyperkalemia.
Her current eGFR is 15 ml/min, potassium is 5.1 mEq/L, and hemoglobin is 10.2 g/dL.
Which of the following would provide the highest survival benefit in this patient?

• A)Cadaveric renal transplant
• B)Early initiation (preemptive) of hemodialysis
• C)Erythropoietin therapy
• D)Hemodialysis at onset of uremia symptoms
• E)Peritoneal dialysis

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