Potassium Supplement Hyperkalaemia CKD — ESENeph MCQ

Correct answer: B — Dialysis access steal causing clinically significant hand ischaemia

The best answer is “Dialysis access steal causing clinically significant hand ischaemia”. Access compression restoring distal perfusion is a classic functional clue. Motor deficit, rest pain or tissue threat requires urgent vascular-access assessment rather than routine observation. “Central venous stenosis causing access-arm venous hypertension” is less appropriate because that typically produces arm swelling and access-pressure abnormalities rather than compression-relieved distal ischaemia “Dialyser hypersensitivity causing systemic symptoms during dialysis” is less appropriate because dialyser reactions are systemic and do not resolve with fistula compression “Calciphylaxis causing painful fixed digital skin necrosis” is less appropriate because calciphylaxis produces painful skin lesions rather than access-dependent flow diversion “Carpal tunnel syndrome causing median-nerve sensory symptoms” is less appropriate because median neuropathy does not explain the vascular signs and compression response

Reference: UK Kidney Association vascular access for haemodialysis guideline: https://www.ukkidney.org/health-professionals/guidelines/vascular-access-haemodialysis-0