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Dialysis disequilibrium syndrome — ESENeph MCQ

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HardDialysisDialysis disequilibrium syndromeESENeph

A clinically stable thrice-weekly haemodialysis patient has persistently low delivered adequacy despite prescribed time being unchanged. What should be checked first?

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Correct answer: C — Assess access function, treatment interruptions and delivered clearance

The best answer is “Assess access function, treatment interruptions and delivered clearance”. Low measured dialysis adequacy should trigger review of what was actually delivered, including access performance, blood and dialysate flow, recirculation, interruptions and treatment duration. “Assume prescribed treatment time proves adequate clearance” ignores discrepancies between prescription and delivery. “Reduce blood-flow rate to limit delivered solute clearance” would worsen adequacy. “Shorten treatment while preserving the current dialysis prescription” further reduces delivered clearance. “Replace haemodialysis with plasma exchange for solute removal” is not a treatment for inadequate dialysis delivery.

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