Take Quiz-Section 2
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A 46-year-old man with hypertension, diabetes, prior CVA with right residual weakness, visual impairment, heart failure with reduced ejection fraction (EF 35%), and CKD stage 5 presents for follow up with his wife who is very much involved in his care. Various renal replacement therapy options are discussed. He is currently on disability but his wife works full time. Over the last year, he has had three admissions for heart failure exacerbation because of dietary and medication non-adherence despite multiple counseling sessions.
Which of the following poses the highest risk for home hemodialysis treatment failure?
A 58-year-old female with a medical history of hypertension, diabetes, coronary artery disease, and ESRD was recently started on home HD. She is well read and curious to know her risk of hospitalization as compared with in-center HD. Which of the following statement is correct regarding hospitalization for home hemodialysis patient compared to in center HD?
A 76 year old male with ESKD secondary to ANCA vasculitis has started training for home hemodialysis. He is currently undergoing in-center HD for last 1 months and now in transition care unit. He had 1+ peripheral edema and pre dialysis BP in range 130-140/70-80. His medications include carvedilol 25 mg BID, hydralazine 50 mg TID, aspirin 81 mg OD, atorvastatin 80 mg OD, sevelamer 800 mg TIDWM. He develops severe intradialytic hypotension on Day 4 of training with systolic in 80s. He was asymptomatic during this event. Which of the following factors have contributed to severe intradialytic hypotension?
A 66-year-old man with HTN, ESKD is currently on home HD (HHD) for last 6 months. He has left forearm fistula with good thrill and bruit, last angioplasty was 3 month back. He appears euvolemic but has lost 6 lbs in last 3 months. His dialysis prescription is spKT/V per week 2, dry weight 67 kg, treatment time of 3.5 hours for 5 days per week with total weekly UF volume of 7 L. Laboratory testing is below.
| Lab | Predialysis | Postdialysis |
|---|---|---|
| Na meq/L | 138 | 139 |
| K meq/L | 5.1 | 3.8 |
| Cl meq/L | 99 | 98 |
| CO2 meq/L | 24 | 20 |
| Anion gap | 13 | 17 |
Your medical student rotating with you is worried that patient has lower bicarbonate post dialysis. What will be your answer?
For a 100-kg male (assume TBW = 50 L), please provide dialysate volume needed for six treatments per week home hemodialysis to achieve a target stdKt/V of 2.0? Consider blood flow (Qb) is 400 mL/min and there is negligible ultrafiltration during treatment.