Thursday, December 12, 2013

Clinical Case 78: Answers and Summary

Which one of the following are items to assess when solute clearance per session in HD is marginal?

Adequacy of the blood flow from the access
  14 (63%)
Dialysate flow rate
  8 (36%)
Dialyzer surface area
  10 (45%)
Duration of dialysis
  18 (81%)
Blood pump speed
  8 (36%)
Serum potassium pre dialysis level
  2 (9%)
Dialysate pathway stagnation
  4 (18%)
Serum sodium pre dialysis concentration
  2 (9%)

All the above need to be assessed to see if the clearance is good for HD session. Serum K and Na pre dialysis has not been evaluated to have any clearance related benefit. Access, dialysis flow rate, blood flow rate, duration of dialysis being the most important followed by blood pump speed, pathway stagnation, fiber bundle clotting, dialyzer surface area are also important components. Check out the free access HD core curriculum in AJKD 2013 for an excellent review on this topic. Watch out for an eAJKD quiz on this topic coming soon as well.

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