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Emergency Dialysis — RACP Adult Medicine MCQ

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EasyNephrologyEmergency DialysisRACP Adult Medicine

A 55-year-old man with ESKD (eGFR 8 mL/min/1.73m²) presents with refractory hyperkalaemia (K⁺ 7.5 mmol/L) unresponsive to medical therapy, fluid overload with pulmonary oedema despite IV furosemide, and uraemic pericarditis (pleuritic chest pain with pericardial rub). He has no dialysis access. What is the most appropriate initial dialysis modality?

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Correct answer: E — Haemodialysis via tunnelled central venous catheter

Emergency dialysis indications: refractory hyperkalaemia, refractory fluid overload, uraemic pericarditis, uraemic encephalopathy, and severe metabolic acidosis. Without pre-existing access, a temporary or tunnelled central venous catheter (internal jugular preferred) is inserted for urgent haemodialysis. AV fistula requires 6–8 weeks maturation; PD catheter requires 2 weeks before use.

Reference: KHA-CARI – 2024 – Dialysis Initiation; KDIGO 2024