Underdialysis Uraemic Symptoms KtV — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

EasyHaemodialysisUnderdialysis Uraemic Symptoms KtVESENeph

A 66-year-old man on haemodialysis develops intractable hiccups, morning nausea, and a metallic taste. His spKt/V is 1.1 (target >1.2). He has been missing the last 30 minutes of sessions due to cramps. Pre-dialysis urea is 38 mmol/L. What is the most likely cause of his symptoms?

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

Reveal the answer and explanation

Correct answer: D — Inadequate dialysis (underdialysis)

The combination of intractable hiccups, early-morning nausea, and metallic taste are classic uraemic symptoms indicating inadequate solute clearance. The spKt/V of 1.1 is below the KDIGO minimum target of 1.2 for thrice-weekly HD. The patient is shortening sessions (missing 30 minutes due to cramps), which directly reduces dialysis adequacy. The pre-dialysis urea of 38 mmol/L is elevated. Management should focus on addressing the intradialytic cramps (reassess dry weight, adjust UF rate) to ensure complete sessions, thereby improving adequacy and resolving uraemic symptoms. Increasing session time or frequency may be needed.

Reference: KDIGO 2015 – HD Adequacy; UKKA 2019 – HD Guidelines; Daugirdas 2015 – Handbook of Dialysis