April

Question Title

* According the KDOQI Guidelines for pediatric vascular access, which characteristic indicates a patient should be referred for permanent vascular access placement?

The correct answer is a. Weight of 25 kg (55 lb).

Rationale: Serious consideration should be given to placing permanent vascular access in children greater than 20 kg who are expected to wait more than 1 year for a kidney transplant. A central venous catheter may be acceptable for patients bridging on hemodialysis awaiting transition to peritoneal dialysis.

Reference: ANNA Core Curriculum for Nephrology Nursing, 7th ed., page 1473
November

Question Title

* During rounds in an in-center hemodialysis facility, the NP notes that a patient is prescribed pregabalin (Lyrica) 75 mg BID for neuropathic pain.  Which of these actions should the NP take?

The correct answer is a. decrease the dose.

Rationale: Pregabalin is primarily excreted by the kidney and requires dosage adjustment in patients with kidney disease. It is also removed by conventional dialysis, and a supplemental dose is required post-hemodialysis. Both the prescribed Lyrica dose and the supplemental dose are too high for a patient with ESRD on hemodialysis.

Reference: Lexicomp, Drug Information Handbook for Advanced Practice Nursing, 17th ed., page 1862 - for eGFR < 15 mL/min - single daily dose of 25-75 mg; Post-hemodialysis supplemental dosage as a single supplemental dose based on usual daily dose, e.g., “25 mg/day schedule: Single supplementary dose of 25 mg or 50 mg.”

 
June

Question Title

* The NP is teaching a patient who is in peritoneal dialysis (PD) training about the need for routine dialysis adequacy testing.  The NP should explain that the most common reason for a reduction in PD adequacy is

 

The correct answer b. decreasing residual kidney function.

Rationale: Residual kidney function can account for approximately 50% of the clearance of salt, water, small and medium size solutes in new-start patients on PD.  As residual kidney function decreases, so does adequacy.

Reference: References: Daugirdas, J. T., et al. (2015). Handbook of Dialysis, 5th ed., pp. 406, 468, 471, & 476; Gilbert. S.J., & Weiner, D.E. (Eds.). (2018). NKF Primer on Kidney Diseases, 7th ed., pp. 546, 550.
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