Dialysis Adequacy and Prescription Flashcards

How is residual renal function (RRF) factored into the overall dialysis adequacy assessment?

Answer: RRF contributes to total weekly clearance and may allow reduced treatment frequency

Residual renal function contributes to total weekly solute clearance and middle molecule removal, potentially supporting reduced dialysis frequency or session length.

What does the term 'dry weight' mean in the context of hemodialysis?

Answer: Lowest tolerated post-dialysis weight without hypotension or symptoms

Dry weight is the lowest post-dialysis weight a patient can tolerate without symptoms of hypovolemia, reflecting euvolemic or normovolemic state.

Which patient symptom suggests the dry weight target needs to be increased?

Answer: Persistent hypotension and cramping during dialysis

Persistent hypotension and cramping during dialysis indicate the fluid removal target may be set too aggressively, and the dry weight may need upward adjustment.

Which type of dialyzer membrane is associated with the highest biocompatibility?

Answer: Synthetic polymer (polysulfone)

Synthetic polymer membranes such as polysulfone demonstrate the highest biocompatibility, activating complement and inflammatory pathways less than cellulosic membranes.

What is the purpose of measuring post-dialysis BUN 30–60 seconds after stopping the blood pump (slow-flow sample)?

Answer: To allow cardiopulmonary recirculation to equilibrate for accurate Kt/V calculation

The slow-flow or stopped-pump post-dialysis BUN sample allows cardiopulmonary recirculation to equilibrate, providing a more accurate measure of total body urea for Kt/V calculation.

A dialysis patient consistently achieves Kt/V of 1.0 despite correct treatment prescription. What is the most likely cause?

Answer: Access recirculation reducing effective clearance

Access recirculation allows already-dialyzed blood to re-enter the arterial needle, reducing effective urea clearance and resulting in lower-than-expected Kt/V values.