A patient with long-standing kidney disease has a glomerular filtration rate of 18 mL/min/1.73 m2. Which intervention is likely part of the care plan?

• A. Dialysis or renal transplantation
• B. Increased protein intake
• C. Start diuretic therapy only
• D. No intervention required

Answer: (A)

When glomerular filtration is this low, the kidneys can no longer maintain essential balance mechanisms, so active renal replacement becomes necessary. A GFR of 18 mL/min/1.73 m2 places the patient in advanced CKD, where waste products, fluid, and electrolyte management, as well as acid-base control, typically require support beyond the kidneys’ remaining function. The care plan in this situation centers on preparing for and initiating renal replacement therapy, with dialysis or a kidney transplant being the main options to sustain life and quality of life. Dialysis provides an artificial filtration to remove waste and excess fluid, while a transplant offers the possibility of restoring kidney function. Increasing protein intake would not address the underlying filtration failure and could worsen uremia; diuretic therapy alone is insufficient to manage the complex needs at this level of kidney injury; and no intervention would ignore the clear decline in renal function.