Dialysis has evolved as we learn more about uremia. In addition, recent studies have answered some important questions regarding timing and duration of dialysis. Golper et al discuss hemodialysis in a Core Curriculum published by AJKD. The following questions will test your knowledge on this very important topic:

1. The per treatment Kt/V for short daily HD (with the NxStage system) is about 0.45. How many treatments per week are necessary to achieve an equivalent clearance to thrice weekly in-center hemodialysis?

A. 3

B. 4

C. >5

2. ACE inhibitors predispose patients to anaphylactic reaction when exposed to which of the following dialyzers?

A. Cellulosic

B. Polyacrylnitrile

C. Polysulfone

3. Sodium removal in hemodialysis is achieved primarily by:

A. Diffusion

B. Convection

C. Convection and diffusion

D. Osmosis

4. The DOPPS study (Dialysis Outcomes and Practice Patterns Study) observed a 45% higher risk of death in patients with pre-dialysis sodium levels less than:

A. <140 mEq/dL

B. <137 mEq/dL

C. <130 mEq/dL

D. <125 mEq/dL

5. A 50-year-old emaciated woman with ESRD secondary to lupus nephritis is admitted with catheter related bacteremia that is successfully treated with antibiotics. During the course of her hospitalization, she is noted to have a pre-dialysis bicarbonate concentration consistently >24 mEq/dL. The best approach to this electrolyte problem is:

A. Decrease the dialysate bicarbonate to 30 mEq/dL

B. Increase the BFR from 300 mL/min to 400 mL/min

C. Calorie count and nutritional evaluation

6. A 45-year-old man with CKD stage 5 secondary to DM is on lantus 30 units SQ at bedtime. He is started on HD a few months later, but develops frequent hypoglycemic episodes. The most likely reason for this is:

A. During dialysis, there is a net diffusive loss of glucose leading to hypoglycemia

B. Improved peripheral responsiveness to insulin after starting dialysis

C. Half-life of insulin is prolonged in kidney disease

Post prepared by Rimda Wanchoo, MD, Assistant Prof of Medicine, Hofstra NSLIJ School of Medicine.

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