barriers to HHD
A 47 year old woman with CKD stage 5 due to lupus nephritis presents for follow up. She has already elected to dialyze in-center, and she has a mature left radiocephalic AV fistula. She lives with her husband and two children, and she works a full time job from home. Today she expresses apprehension about starting dialysis, especially needing to go to the center three times weekly. She remembers learning about home dialysis a while ago, but now she cannot recall details between different modalities. She says she elected in-center because that is what most people do.
Q WHAT IS THE BEST WAY TO PROCEED?
A. Reassure her about in-center HD
B. Stop the in-center HD referral and start a home HD referral
C. Stop the in-center HD referral and start a home PD referral
D. Re-educate her on different dialysis modalities
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Q WHAT IS THE BEST WAY TO PROCEED?
A. Reassure her about in-center HD
B. Stop the in-center HD referral and start a home HD referral
C. Stop the in-center HD referral and start a home PD referral
D. Re-educate her on different dialysis modalities
Click here for answer, explanation, and additional reading
PRESCRIPTION WRITING
The patient in the previous example (47 year old woman with CKD 5 from lupus nephritis who is approaching ESRD) elected to pursue home HD. She has been trained, her home inspected, and she has the NxStage at home ready to use.
She has mild fatigue and morning nausea, but otherwise no chest pain, SOB, abdominal pain, vomitting, itching, or disguise.
She weighs 70 kg, BP is 130/80, euvolemic on exam, no pericardial friction rub, left AVF has a continuous thrill and bruit, and her laboratories are unremarkable.
Q1 What is the first step in developing a HHD prescription?
A. Choosing how many days per week to dialyze
B. Choosing blood flow rate
C. Choosing how dialysate volume per treatment
D. Choosing time per HD session
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You start her on five treatments per week and she is doing well with no major issues.
Her current prescription on 5 days per week is a Vd 30 L, Qb 400 ml/min, and FF 0.5.
Her vitals signs, exam, and laborites are all in a normal or acceptable range. She comes to clinic today to ask if dialysis can be changed to only four days a week instead.
Q2. WHAT IS THE BEST ADJUSTMENT TO MAKE TO ACCOMMODATE FOUR DAYS PER WEEK?
A. No further change, just decrease to four days
B. Increase Vd to 35 L
C. Decrease FF to 0.3
D. Increase Qb to 450 ml/min
Click here for answer, explanation, and additional reading
She has mild fatigue and morning nausea, but otherwise no chest pain, SOB, abdominal pain, vomitting, itching, or disguise.
She weighs 70 kg, BP is 130/80, euvolemic on exam, no pericardial friction rub, left AVF has a continuous thrill and bruit, and her laboratories are unremarkable.
Q1 What is the first step in developing a HHD prescription?
A. Choosing how many days per week to dialyze
B. Choosing blood flow rate
C. Choosing how dialysate volume per treatment
D. Choosing time per HD session
Click here for answer, explanation, and additional reading
You start her on five treatments per week and she is doing well with no major issues.
Her current prescription on 5 days per week is a Vd 30 L, Qb 400 ml/min, and FF 0.5.
Her vitals signs, exam, and laborites are all in a normal or acceptable range. She comes to clinic today to ask if dialysis can be changed to only four days a week instead.
Q2. WHAT IS THE BEST ADJUSTMENT TO MAKE TO ACCOMMODATE FOUR DAYS PER WEEK?
A. No further change, just decrease to four days
B. Increase Vd to 35 L
C. Decrease FF to 0.3
D. Increase Qb to 450 ml/min
Click here for answer, explanation, and additional reading
Access Issues
A 47 year old man with ESRD 2/2 diabetic kidney disease is preparing for dialysis, and he actively undergoing training to perform hemodialysis at home. He has a left AVF which has recently matured. He would much rather do dialysis at home because it fits within his day-to-day lifestyle better, but he is expresses a lot of hesitation and anxiety about self-cannulation.
Q1 WHICH OF THE FOLLOWING QUESTIONS IS THE MOST HELPFUL IN ASSESSING A PATIENT WHO HAS PERCEIVED FEARS OF SELF-CANNULATION?
A. Have you ever self-cannulated before?
B. How well do you tolerate needle insertion for blood tests?
C. Do you prefer someone else to cannulate you?
D. Do you prefer blunt needles
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After speaking to him about self-cannulation, he feels a little better. However, he says he learned about different cannulation techniques. He likes the idea of buttonhole cannulation because if the blunt needle.
Q2 WHICH OF THE FOLLOWING IS NOT TRUE ABOUT BUTTONHOLE CANNULATION?
A. It is the recommended route of cannulation for home hemodialysis
B. Requires an nearly exact cannulation angle and route every time
C. It carries an increased risk of infection
D. It requires removal of a surface-level scab prior to cannulation
Click here for answer, explanation and additional reading
Q1 WHICH OF THE FOLLOWING QUESTIONS IS THE MOST HELPFUL IN ASSESSING A PATIENT WHO HAS PERCEIVED FEARS OF SELF-CANNULATION?
A. Have you ever self-cannulated before?
B. How well do you tolerate needle insertion for blood tests?
C. Do you prefer someone else to cannulate you?
D. Do you prefer blunt needles
Click here for answer, explanation, and additional reading
After speaking to him about self-cannulation, he feels a little better. However, he says he learned about different cannulation techniques. He likes the idea of buttonhole cannulation because if the blunt needle.
Q2 WHICH OF THE FOLLOWING IS NOT TRUE ABOUT BUTTONHOLE CANNULATION?
A. It is the recommended route of cannulation for home hemodialysis
B. Requires an nearly exact cannulation angle and route every time
C. It carries an increased risk of infection
D. It requires removal of a surface-level scab prior to cannulation
Click here for answer, explanation and additional reading