P26002 CKD Pre-Assessment – Medical Learning Institute Inc

Pre-Assessment

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1a. According to the KDIGO 2024 Clinical Practice Guidelines, which of the following combinations of estimated GFR and ACR values is associated with the least risk of chronic kidney disease (CKD) and cardiovascular disease (CVD)?

a. GFR <60 ml/min per 1.73m2 and ACR <30 mg/g
b. GFR ≥60 ml/min per 1.73m2 and ACR <30 mg/g
c. GFR <60 ml/min per 1.73m2 and ACR ≥30 mg/g
d. GFR ≥60 ml/min per 1.73m2 and ACR ≥30 mg/g

1b. Please select the extent to which you feel confident in your answer

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2a. How would you approach discussion of risk for CKD/CVD with a 42-year-old man with a BMI of 30 kg/m2, HbA1C of 6.0%, and mild hypertension (BP 134/80 mmHg on medication) who does not currently meet the estimated GFR and ACR criteria for clinical CKD?

a. Discuss the risk for CKD/CVD with this patient as soon as convenient
b. Observe and discuss the risk for CKD/CVD only if GFR or ACR values are in the abnormal range for ≥3 months
c. Observe and discuss the risk for CKD/CVD only if the patient’s HbA1C reaches ≥6.5%
d. Wait to discuss the risk for CKD/CVD until the patient is ≥55 years old

2b. Please select the extent to which you feel confident in your answer

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3a. Which of the following treatment(s) would you most likely add next to the management plan for a 68-year-old woman with poorly controlled Type-2 diabetes (T2D; HbA1C 8.0%), HTN (BP 150/90 mmHg), history of prior acute myocardial infarction, and established CKD (eGFR 58 ml/min per 1.73m2) who is currently receiving metformin and a statin?

3b. Please select the extent to which you feel confident in your answer

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4a. For which of the following patient types would you most likely recommend a clinical trial investigating the combination of an aldosterone synthase inhibitor (ASI) and an SGLT2 inhibitor?

a. A patient with T2D and no evidence of CKD
b. A patient with T2D, poorly controlled HTN, and Stage 1 CKD
c. A patient with T2D, poorly controlled HTN, and Stage 4 CKD
d. A patient with HTN and no evidence of CKD

4b. Please select the extent to which you feel confident in your answer

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5a. A 58-year-old man with a history of T2D, HTN and Stage 3 CKD (eGFR 50 ml/min per 1.73m2) reports new symptom of persistent swelling in his ankles. How should the PCP approach management of the patient at this time?

a. Immediately consult with a cardiologist for evaluation of worsening heart disease
b. Immediately consult with a nephrologist for evaluation of worsening kidney disease
c. Evaluate and recommend referral to a cardiologist or nephrologist as necessary
d. Observe and consult with a nephrologist if symptoms worsen in 3 months

Practice the diabetes

5b. Please select the extent to which you feel confident in your answer

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6a. Which of the following strategies is most appropriate to counsel a patient with prediabetes, controlled HTN, albuminuria (uACR 90 mg/g), and a history of smoking on the risk for CKD and CVD?

a. Reinforce statistics that show the impact of multiple risk factors on kidney and heart disease
b. Focus on small, achievable steps to manage one factor at a time
c. Suggest working together to change the patient’s lifestyle
d. Advise the patient to stop smoking to avoid the risk of a heart attack

6b. Please select the extent to which you feel confident in your answer

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7a. How confident are you in your ability to screen for, educate, and treat patients with CKD using current evidence-based approaches?