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Dialysis indication — RCPSC IM MCQ

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HardNephrologyDialysis indicationRCPSC IM

A patient who missed hemodialysis has confusion, potassium 6.8 mmol/L after temporizing therapy, pH 7.08, pulmonary edema despite diuretic treatment and rising oxygen requirements. What is the next definitive intervention?

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Correct answer: A — Start emergency hemodialysis for the refractory complications

The best answer is “Start emergency hemodialysis for the refractory complications”. Several independent emergency dialysis indications coexist: refractory hyperkalemia, severe acidosis, pulmonary edema and uremic neurologic symptoms. Temporizing or oral treatments cannot provide adequate definitive correction, and outpatient planning is unsafe. Persistent hyperkalemia with recurrent electrocardiographic toxicity, severe acidaemia and refractory pulmonary edema are each accepted urgent indications; their concurrence makes further temporizing therapy alone inadequate.

Reference: Kidney Foundation of Canada, kidney failure and acute kidney injury. https://kidney.ca/kidney-health/your-kidneys/what-is-kidney-disease