Intradialytic hypotension — ESENeph MCQ

Correct answer: C — Reduce ultrafiltration intensity through fluid and treatment-time review

The best answer is “Reduce ultrafiltration intensity through fluid and treatment-time review”. UKKA notes that ultrafiltration rates above 10 mL/kg/hour are associated with intradialytic hypotension and adverse outcomes. Lower salt-driven weight gain, an accurate target weight and longer or more frequent treatment can reduce the required rate. “Shorten each dialysis treatment while removing the same volume” is less appropriate because this further increases ultrafiltration rate and haemodynamic stress “Raise dialysate potassium as the complete intervention” is less appropriate because this does not correct the excessive volume-removal rate driving the episodes “Give prophylactic antibiotics before each treatment” is less appropriate because there is no evidence of infection and antibiotics do not correct dialysis haemodynamics “Stop maintenance dialysis after the next episode” is less appropriate because the correct response is prescription and volume-management review rather than abandonment of kidney replacement therapy

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