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Perioperative Dialysis Scheduling — ESENeph MCQ

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ModerateHaemodialysisPerioperative Dialysis SchedulingESENeph

A 65-year-old man with CKD G5D on haemodialysis is admitted to hospital for an unrelated surgical procedure. His usual dialysis schedule is Monday/Wednesday/Friday. Surgery is scheduled for Wednesday. What dialysis scheduling consideration is important?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Ensure dialysis is performed the day before surgery (Tuesday) to optimise electrolytes and fluid status; use heparin-free or reduced-heparin dialysis to minimise perioperative bleeding; coordinate post-operative dialysis timing with surgical team

Perioperative dialysis management requires careful planning: (1) Perform dialysis the day before surgery to optimise potassium, acid-base, and fluid status; (2) Use heparin-free or minimal-heparin dialysis to reduce perioperative bleeding risk; (3) Monitor potassium closely peri-operatively (risk of hyperK from tissue trauma, blood transfusion, fasting); (4) Coordinate post-operative dialysis timing with the surgical team; (5) Adjust medications (e.g. hold antihypertensives pre-operatively if hypotension risk). Communication between nephrology, surgery, and anaesthesia teams is essential.

Reference: KDOQI 2015 – HD Adequacy; UKKA – Perioperative Dialysis Guidance