Hemodialysis Principles and Practices Flashcards

The fluid restriction for most patients undergoing in-center hemodialysis is equal to urine volume/day plus:

Answer: 1 L.

For most in-center hemodialysis patients, a common fluid restriction guideline is to limit daily fluid intake to their residual urine output plus 1 liter. This additional liter accounts for insensible fluid losses (e.g., through breathing and sweat) and helps prevent excessive fluid accumulation between dialysis sessions.

Failure to excrete beta2-microglobulin in patients with kidney failure predisposes the patient to:

Answer: amyloidosis.

Beta2-microglobulin is a small protein that is normally filtered and reabsorbed by healthy kidneys. In patients with kidney failure, it accumulates in the blood and can deposit in various tissues, forming amyloid fibrils. This deposition leads to dialysis-related amyloidosis, which can affect joints, bones, and other organs.

Blood tests for ferritin are performed in hemodialysis patients:

Answer: to check for iron stores.

Ferritin is a protein that stores iron in the body, and its levels in the blood reflect the body's total iron stores. Hemodialysis patients are often anemic and require iron supplementation, so ferritin levels are regularly monitored to assess iron status and guide treatment to prevent iron deficiency or overload.

Which of the following phosphate binders would best control hyperphosphatemia with the fewest side effects in patients with end-stage kidney disease?

Answer: Lanthanum carbonate

Lanthanum carbonate is a non-calcium, non-aluminum-based phosphate binder that effectively reduces serum phosphate levels in patients with end-stage kidney disease. It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption. Compared to older binders like aluminum hydroxide or calcium carbonate, it generally has fewer systemic side effects and a better safety profile.

Hemodialysis patients should be taught to:

Answer: All of the above.

Patient education and self-management are crucial for hemodialysis patients to achieve optimal outcomes and independence. Teaching patients to weigh themselves, record fluid intake, check dialyzer settings, and even perform self-cannulation (putting in their own needles) empowers them to actively participate in their care and identify potential issues early.

All of the following statements about vitamins in dialysis patients are true EXCEPT:

Answer: dialysis does not remove water-soluble vitamins.

Dialysis is designed to remove waste products and excess fluid, and in doing so, it also removes water-soluble vitamins from the blood. Therefore, dialysis patients typically require supplementation with B-complex vitamins and vitamin C. Fat-soluble vitamins (A, D, E, K) are generally not removed by dialysis.

Biocompatibility is best illustrated by:

Answer: reprocessed dialyzers that have better biocompatibility than new ones.

Biocompatibility refers to how well a material interacts with the body's biological systems without causing adverse reactions. Reprocessing dialyzers can sometimes improve biocompatibility by removing residual manufacturing chemicals or by conditioning the membrane surface, leading to a reduced inflammatory response compared to a brand-new dialyzer.