Health Promotion, Patient Education, and Counseling
This domain tests what you teach and how you teach it: the dietary, behavioral, and preventive interventions that change outcomes, delivered at the right time and in a format the patient can act on.
Core teaching targets
Sodium under 2 g/day (about 5 g salt); protein 0.8 g/kg/day in CKD without dialysis, higher for dialysis patients; individualized potassium and phosphorus counseling that names real foods rather than issuing a generic sheet. Smoking cessation, weight and glycemic control, physical activity. Vaccinate: hepatitis B (higher doses, then check anti-HBs titers), influenza annually, pneumococcal, COVID-19, and zoster by age.
Protect the kidneys and the future access
Avoid NSAIDs, unregulated herbal products, and aminoglycosides. Do not withhold indicated iodinated contrast; use the lowest diagnostic volume, hydrate, and avoid concurrent nephrotoxins. Once CKD G4 is known, protect the non-dominant arm: no venipuncture, IV lines, or blood pressure cuffs on the side of a possible fistula.
Start modality education early
Begin dialysis-modality and transplant education at CKD G4 (eGFR <30) so the patient can weigh in-center hemodialysis, home hemodialysis, peritoneal dialysis, transplant, or conservative management without urgency. Include advance care planning in that conversation.
Worked example
A patient with eGFR 22 asks whether to skip a contrast CT for a suspected abscess. Correct response: the abscess is the immediate threat, so proceed with the study using low-osmolar contrast at the lowest diagnostic volume, ensure hydration, and hold NSAIDs and other nephrotoxins around it. Do not delay a needed study out of contrast fear.
Traps that cost marks
Blanket "avoid contrast" advice. Handing out diet sheets without teach-back. Raising dialysis only after an urgent inpatient start.