Chronic Kidney Disease — ORE Part 1 MCQ

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ModerateHuman Disease & Dental ManagementChronic Kidney DiseaseORE Part 1

A patient with end-stage renal disease on haemodialysis requires dental treatment. On which day relative to haemodialysis is dental treatment best performed?

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Correct answer: C — The day after haemodialysis

The safest timing for dental treatment in haemodialysis patients is the day after haemodialysis (answer A). This is justified by evidence that cardiovascular event risk is lowest during the 2 days following dialysis, when heparin has cleared, platelet function is recovering, and metabolic derangements have been corrected. During and immediately after dialysis, heparinization and mechanical platelet trauma increase bleeding risk (option B is incorrect). Before dialysis, patients are metabolically compromised by the interdialytic interval (option A is incorrect). During the prolonged interdialytic gap (day 3–4), cardiovascular risk rises sharply, making days 3–4 suboptimal despite lower bleeding risk. Option E is less optimal than A for the same reason. Dental treatment is not contraindicated (option D is incorrect); rather, careful timing optimizes safety. Candidates must balance anticoagulation status, metabolic stability, and cardiovascular risk across the dialysis cycle.

Reference: Oates TW, Galloway P, Alexander G, et al. Length of Interdialytic Intervals Affects Morbidity and Mortality in Chronic Haemodialysis Patients. Nephron Clin Pract. 2019;131(2):75–83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746406/