Haemodialysis adequacy failure — ESENeph MCQ

Correct answer: C — Measure vascular-access recirculation and access flow

The best answer is “Measure vascular-access recirculation and access flow”. Access recirculation returns dialysed blood to the dialyser and lowers effective clearance. Flow and recirculation testing, needle position and prescription delivery are checked before merely increasing nominal dialysis time. “Measure urinary albumin excretion as the explanation for low delivered dialysis” is less appropriate because albuminuria does not measure extracorporeal circuit efficiency “Shorten treatment time before checking the access” is less appropriate because this further reduces delivered dialysis dose “Increase dietary protein to correct the Kt/V calculation” is less appropriate because nutrition does not resolve access recirculation “Assume the laboratory result is adequate because the patient attends” is less appropriate because persistent low clearance with full attendance requires circuit and access evaluation

Reference: UK Kidney Association haemodialysis guideline: https://guidelines.ukkidney.org/haemodialysis/