, DAVITA STUDY GUIDE BEST 2025-2026 QUIZLET EXAM
QUESTIONS AND CORRECT ANSWERS FOR ALL
COURSES, PERFECT FOR STUDENTS PREPARING FOR
MIDTERMS AND FINALS - 239 Questions
This exam assesses mastery of CKD staging, risk stratification, metabolic complications, pharmacotherapy, and
evidence-based management per current KDIGO guidelines. Questions require synthesis of pathophysiology,
clinical data, and treatment algorithms. It contains 239 multiple-choice questions, each with four distractors and
a fully worked rationale that explains why the keyed answer is correct. Content is organized into 10 focused
sections: Chronic Kidney Disease (CKD) Staging and Management, Hemodialysis and Peritoneal Dialysis
Procedures, Vascular Access Care and Complications, Fluid and Electrolyte Balance, Acid-Base Disorders,
Anemia of Chronic Kidney Disease, Bone and Mineral Metabolism Disorders, Nutritional Management in
Dialysis, Infection Control and Prevention, Patient Education and Self-Care. Targeted learning outcomes include:
Accurately stage CKD using eGFR and albuminuria categories; Manage hypertension, anemia, mineral bone
disorder, and metabolic acidosis in CKD; Select appropriate renoprotective therapies and avoid nephrotoxic
agents; Interpret laboratory trends to guide timing of renal replacement therapy. Every item has been reviewed
for clinical accuracy, current guidelines, and clarity so that students can study with confidence and self-correct as
they work through the bank. Use it as a high-yield review immediately before the exam, or as a structured practice
tool during the unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours,
with a passing score of 70%. Aligned with Designed to meet USMLE Step 2 CK and internal medicine clerkship
Section 1: Chronic Kidney Disease (CKD) Staging and Management (Questions 1-25)
1 A patient with eGFR 38 mL/min/1.73 m² and ACR 45 mg/g has which CKD
stage and risk category per KDIGO?
A) Stage G3a, moderate risk
B) Stage G3b, high risk
C) Stage G3a, high risk
D) Stage G3b, very high risk
Answer: B
Rationale: eGFR 38 falls in G3b (30-44). ACR 45 mg/g is A2 (30-300). G3b+A2 is
high risk. G3a is 45-59; moderate risk would require A1. Very high risk requires A3
or G4+.
2 In a patient with CKD G4 and hypertension, which antihypertensive combination
is most renoprotective per KDIGO 2024 guidelines?
A) Amlodipine + metoprolol
B) Lisinopril + chlorthalidone
C) Losartan + amlodipine
D) Hydralazine + isosorbide dinitrate
Answer: B
,Rationale: ACEi/ARB + thiazide-like diuretic is first-line for CKD with
hypertension. Chlorthalidone is preferred over HCTZ in CKD. Amlodipine is less
renoprotective; beta-blockers are not first-line. Hydralazine/ISDN is reserved for
resistant hypertension.
3 A patient with CKD G4 has hemoglobin 9.1 g/dL, ferritin 200 ng/mL, TSAT 22%.
Which initial therapy is indicated?
A) Erythropoiesis-stimulating agent (ESA) alone
B) Intravenous iron alone
C) Oral iron supplementation
D) ESA plus intravenous iron
Answer: B
Rationale: TSAT <30% and ferritin <300 indicate functional iron deficiency. IV iron
is preferred in CKD G4 due to better absorption. ESA is reserved for Hb <9 after
iron repletion or if Hb <8. Oral iron is ineffective in advanced CKD.
4 For a patient with CKD G3b and serum bicarbonate 18 mEq/L, which intervention
is recommended?
A) Sodium bicarbonate supplementation to target >22 mEq/L
B) No treatment unless bicarbonate <15 mEq/L
C) Restrict dietary protein to 0.6 g/kg/day
D) Start sevelamer carbonate
Answer: A
Rationale: KDIGO recommends oral bicarbonate for CKD with bicarbonate <22
mEq/L to slow progression. Target >22. Protein restriction is adjunctive but not
primary for acidosis. Sevelamer treats hyperphosphatemia, not acidosis.
5 Which of the following best explains the increased cardiovascular mortality in
CKD G4 compared to dialysis patients?
A) Higher prevalence of sudden cardiac death due to hyperkalemia
B) Competing risk phenomenon: dialysis patients survive longer
C) More aggressive risk factor modification in dialysis patients
D) Paradoxical reduction in blood pressure with dialysis initiation
Answer: B
Rationale: The competing risk phenomenon: dialysis patients must survive to receive
dialysis, so those who die earlier from CVD are counted in the pre-dialysis group.
This creates a survival bias, not lower risk in dialysis.
, 6 In a patient with CKD G4 and serum phosphate 5.8 mg/dL, which combination
best manages hyperphosphatemia while minimizing calcium load?
A) Calcium acetate 667 mg TID with meals
B) Sevelamer carbonate 800 mg TID with meals
C) Lanthanum carbonate 500 mg TID with meals
D) Aluminum hydroxide 600 mg TID with meals
Answer: B
Rationale: Sevelamer is non-calcium based, reducing calcium load and vascular
calcification risk. Calcium acetate adds calcium load. Lanthanum is effective but
more expensive. Aluminum is avoided due to toxicity.
7 A patient with CKD G4 and diabetes has eGFR 28 mL/min/1.73 m², ACR 600
mg/g, HbA1c 7.2%. Which diabetes medication is contraindicated?
A) Metformin
B) Empagliflozin
C) Liraglutide
D) Insulin glargine
Answer: A
Rationale: Metformin is contraindicated when eGFR <30 due to lactic acidosis risk.
Empagliflozin is approved down to eGFR 20 (but efficacy reduced). Liraglutide can
be used. Insulin is safe.
8 Which of the following is the most appropriate first-line therapy for anemia in a
non-dialysis CKD G5 patient with hemoglobin 8.5 g/dL, ferritin 400 ng/mL,
TSAT 35%, and no iron deficiency?
A) Darbepoetin alfa 60 mcg subcutaneously every 2 weeks
B) Blood transfusion to target Hb >10 g/dL
C) Oral ferrous sulfate 325 mg daily
D) No therapy; monitor hemoglobin monthly
Answer: A
Rationale: ESA is indicated for Hb <9 in CKD G5 after iron deficiency excluded.
Darbepoetin is long-acting. Transfusion is reserved for acute symptomatic anemia.
Iron is not needed with TSAT >30% and ferritin >300.
9 In a patient with CKD G3a and stable eGFR 55 mL/min/1.73 m², which dietary
modification is most strongly recommended to slow progression?
A) Restrict dietary sodium to <2 g/day
B) Restrict dietary protein to 0.8 g/kg/day
QUESTIONS AND CORRECT ANSWERS FOR ALL
COURSES, PERFECT FOR STUDENTS PREPARING FOR
MIDTERMS AND FINALS - 239 Questions
This exam assesses mastery of CKD staging, risk stratification, metabolic complications, pharmacotherapy, and
evidence-based management per current KDIGO guidelines. Questions require synthesis of pathophysiology,
clinical data, and treatment algorithms. It contains 239 multiple-choice questions, each with four distractors and
a fully worked rationale that explains why the keyed answer is correct. Content is organized into 10 focused
sections: Chronic Kidney Disease (CKD) Staging and Management, Hemodialysis and Peritoneal Dialysis
Procedures, Vascular Access Care and Complications, Fluid and Electrolyte Balance, Acid-Base Disorders,
Anemia of Chronic Kidney Disease, Bone and Mineral Metabolism Disorders, Nutritional Management in
Dialysis, Infection Control and Prevention, Patient Education and Self-Care. Targeted learning outcomes include:
Accurately stage CKD using eGFR and albuminuria categories; Manage hypertension, anemia, mineral bone
disorder, and metabolic acidosis in CKD; Select appropriate renoprotective therapies and avoid nephrotoxic
agents; Interpret laboratory trends to guide timing of renal replacement therapy. Every item has been reviewed
for clinical accuracy, current guidelines, and clarity so that students can study with confidence and self-correct as
they work through the bank. Use it as a high-yield review immediately before the exam, or as a structured practice
tool during the unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours,
with a passing score of 70%. Aligned with Designed to meet USMLE Step 2 CK and internal medicine clerkship
Section 1: Chronic Kidney Disease (CKD) Staging and Management (Questions 1-25)
1 A patient with eGFR 38 mL/min/1.73 m² and ACR 45 mg/g has which CKD
stage and risk category per KDIGO?
A) Stage G3a, moderate risk
B) Stage G3b, high risk
C) Stage G3a, high risk
D) Stage G3b, very high risk
Answer: B
Rationale: eGFR 38 falls in G3b (30-44). ACR 45 mg/g is A2 (30-300). G3b+A2 is
high risk. G3a is 45-59; moderate risk would require A1. Very high risk requires A3
or G4+.
2 In a patient with CKD G4 and hypertension, which antihypertensive combination
is most renoprotective per KDIGO 2024 guidelines?
A) Amlodipine + metoprolol
B) Lisinopril + chlorthalidone
C) Losartan + amlodipine
D) Hydralazine + isosorbide dinitrate
Answer: B
,Rationale: ACEi/ARB + thiazide-like diuretic is first-line for CKD with
hypertension. Chlorthalidone is preferred over HCTZ in CKD. Amlodipine is less
renoprotective; beta-blockers are not first-line. Hydralazine/ISDN is reserved for
resistant hypertension.
3 A patient with CKD G4 has hemoglobin 9.1 g/dL, ferritin 200 ng/mL, TSAT 22%.
Which initial therapy is indicated?
A) Erythropoiesis-stimulating agent (ESA) alone
B) Intravenous iron alone
C) Oral iron supplementation
D) ESA plus intravenous iron
Answer: B
Rationale: TSAT <30% and ferritin <300 indicate functional iron deficiency. IV iron
is preferred in CKD G4 due to better absorption. ESA is reserved for Hb <9 after
iron repletion or if Hb <8. Oral iron is ineffective in advanced CKD.
4 For a patient with CKD G3b and serum bicarbonate 18 mEq/L, which intervention
is recommended?
A) Sodium bicarbonate supplementation to target >22 mEq/L
B) No treatment unless bicarbonate <15 mEq/L
C) Restrict dietary protein to 0.6 g/kg/day
D) Start sevelamer carbonate
Answer: A
Rationale: KDIGO recommends oral bicarbonate for CKD with bicarbonate <22
mEq/L to slow progression. Target >22. Protein restriction is adjunctive but not
primary for acidosis. Sevelamer treats hyperphosphatemia, not acidosis.
5 Which of the following best explains the increased cardiovascular mortality in
CKD G4 compared to dialysis patients?
A) Higher prevalence of sudden cardiac death due to hyperkalemia
B) Competing risk phenomenon: dialysis patients survive longer
C) More aggressive risk factor modification in dialysis patients
D) Paradoxical reduction in blood pressure with dialysis initiation
Answer: B
Rationale: The competing risk phenomenon: dialysis patients must survive to receive
dialysis, so those who die earlier from CVD are counted in the pre-dialysis group.
This creates a survival bias, not lower risk in dialysis.
, 6 In a patient with CKD G4 and serum phosphate 5.8 mg/dL, which combination
best manages hyperphosphatemia while minimizing calcium load?
A) Calcium acetate 667 mg TID with meals
B) Sevelamer carbonate 800 mg TID with meals
C) Lanthanum carbonate 500 mg TID with meals
D) Aluminum hydroxide 600 mg TID with meals
Answer: B
Rationale: Sevelamer is non-calcium based, reducing calcium load and vascular
calcification risk. Calcium acetate adds calcium load. Lanthanum is effective but
more expensive. Aluminum is avoided due to toxicity.
7 A patient with CKD G4 and diabetes has eGFR 28 mL/min/1.73 m², ACR 600
mg/g, HbA1c 7.2%. Which diabetes medication is contraindicated?
A) Metformin
B) Empagliflozin
C) Liraglutide
D) Insulin glargine
Answer: A
Rationale: Metformin is contraindicated when eGFR <30 due to lactic acidosis risk.
Empagliflozin is approved down to eGFR 20 (but efficacy reduced). Liraglutide can
be used. Insulin is safe.
8 Which of the following is the most appropriate first-line therapy for anemia in a
non-dialysis CKD G5 patient with hemoglobin 8.5 g/dL, ferritin 400 ng/mL,
TSAT 35%, and no iron deficiency?
A) Darbepoetin alfa 60 mcg subcutaneously every 2 weeks
B) Blood transfusion to target Hb >10 g/dL
C) Oral ferrous sulfate 325 mg daily
D) No therapy; monitor hemoglobin monthly
Answer: A
Rationale: ESA is indicated for Hb <9 in CKD G5 after iron deficiency excluded.
Darbepoetin is long-acting. Transfusion is reserved for acute symptomatic anemia.
Iron is not needed with TSAT >30% and ferritin >300.
9 In a patient with CKD G3a and stable eGFR 55 mL/min/1.73 m², which dietary
modification is most strongly recommended to slow progression?
A) Restrict dietary sodium to <2 g/day
B) Restrict dietary protein to 0.8 g/kg/day
