Dialysis Adequacy and Prescription Flashcards

What is a patient's 'dry weight' in the context of hemodialysis?

Answer: The lowest weight a patient can tolerate without experiencing hypotension or cramps

Dry weight (target weight) is the post-dialysis weight at which the patient is euvolemic and does not exhibit signs of over- or under-hydration.

The maximum recommended ultrafiltration rate to minimize intradialytic hypotension and cardiovascular stress is:

Answer: 13 mL/kg/hour

CMS and clinical guidelines recommend keeping ultrafiltration rates below 13 mL/kg/hour to reduce cardiovascular complications and intradialytic hypotension.

Which parameter reflects the ability of a dialyzer to clear small molecules like urea through diffusion?

Answer: KoA (mass transfer area coefficient)

KoA (mass transfer area coefficient) is the product of membrane permeability and surface area, determining diffusive clearance of small solutes.

A dialysis patient has a pre-BUN of 80 mg/dL and a post-BUN of 20 mg/dL. What is the URR?

Answer: 75%

(80 − 20) ÷ 80 × 100 = 60 ÷ 80 × 100 = 75%, indicating adequate dialysis.

Which factor decreases dialysis adequacy (Kt/V) if all other parameters remain constant?

Answer: Increased access recirculation

Access recirculation reduces the effective clearance of urea by mixing dialyzed blood back into the arterial draw, lowering effective Kt/V.

For a patient with a large body size (high V), which adjustment would best maintain adequate Kt/V?

Answer: Increase treatment time or use a higher efficiency dialyzer

Larger patients have a higher urea volume of distribution (V), requiring longer treatment times or higher-efficiency dialyzers to achieve adequate Kt/V.