1.What Is Dialysis Adequacy(KT/V)
✅ Dialysis Adequacy (Kt/V) – MCQs (Set 1)
1. What does "Kt/V" stand for in dialysis adequacy?
A. Kilograms × time / volume
B. Clearance × time / volume of distribution
C. Kidney time over volume
D. Kalemia × total time / volume
➡️ Answer: B. Clearance × time / volume of distribution
2. In the formula Kt/V, “K” refers to:
A. Body weight
B. Blood flow rate
C. Dialyzer urea clearance rate
D. Serum potassium level
➡️ Answer: C. Dialyzer urea clearance rate
3. What is the minimum target Kt/V per dialysis session recommended by KDOQI guidelines?
A. 0.9
B. 1.2
C. 1.5
D. 2.0
➡️ Answer: B. 1.2
4. A low Kt/V may indicate all of the following EXCEPT:
A. Inadequate dialysis time
B. Low blood flow rate
C. High urea clearance
D. Access recirculation
➡️ Answer: C. High urea clearance
5. Kt/V is most commonly used to assess adequacy of:
A. Peritoneal dialysis only
B. Intermittent hemodialysis only
C. Both hemodialysis and peritoneal dialysis
D. CRRT (Continuous Renal Replacement Therapy)
➡️ Answer: C. Both hemodialysis and peritoneal dialysis
6. Which component of Kt/V is typically increased to improve dialysis adequacy?
A. "K" – Clearance (e.g., using high-efficiency dialyzers)
B. "t" – Duration of dialysis
C. Both A and B
D. "V" – Volume of distribution
➡️ Answer: C. Both A and B
7. What does a Kt/V of 0.8 suggest?
A. Excellent dialysis
B. Dialysis is borderline acceptable
C. Dialysis is inadequate
D. Patient needs less frequent dialysis
➡️ Answer: C. Dialysis is inadequate
8. Which of the following may falsely elevate calculated Kt/V?
A. Access recirculation
B. Long dialysis session
C. Low residual renal function
D. Sampling post-BUN too late
➡️ Answer: D. Sampling post-BUN too late
9. What is "V" in the Kt/V formula?
A. Patient's blood volume
B. Total body water or urea distribution volume
C. Volume of dialysate
D. Venous return rate
➡️ Answer: B. Total body water or urea distribution volume
10. If a patient’s Kt/V is consistently below 1.0, what is the best next step?
A. Shorten dialysis time
B. Increase frequency or duration of dialysis
C. Reduce blood flow rate
D. Repeat test in 1 year
➡️ Answer: B. Increase frequency or duration of dialysis
11. Which factor can falsely lower the measured Kt/V?
A. Blood sample drawn too early after dialysis
B. High dialyzer surface area
C. Longer dialysis time
D. Using high-efficiency dialyzer
➡️ Answer: A. Blood sample drawn too early after dialysis
12. A patient receiving 3 sessions/week of hemodialysis has a Kt/V of 1.0. What does this indicate?
A. Adequate dialysis
B. Marginally inadequate dialysis
C. Severe uremia
D. Need for daily dialysis
➡️ Answer: B. Marginally inadequate dialysis
13. In Kt/V, the "V" value can be estimated using which patient factor?
A. Hemoglobin level
B. Dry body weight
C. Serum albumin
D. Blood pressure
➡️ Answer: B. Dry body weight
(V is roughly 55–60% of body weight for adults)
14. Which of the following changes will most effectively increase Kt/V?
A. Increase ultrafiltration
B. Increase dialysate temperature
C. Increase dialysis session duration
D. Decrease dialysate flow
➡️ Answer: C. Increase dialysis session duration
15. What is the main clinical goal of achieving a Kt/V > 1.2?
A. Prevent anemia
B. Improve phosphorus control
C. Reduce uremic symptoms and improve survival
D. Maintain calcium balance
➡️ Answer: C. Reduce uremic symptoms and improve survival
16. What additional measure is often used along with Kt/V to assess dialysis adequacy?
A. Serum potassium
B. Creatinine clearance
C. Urea Reduction Ratio (URR)
D. Serum calcium
➡️ Answer: C. Urea Reduction Ratio (URR)
17. When calculating Kt/V, what does a higher total body water volume (V) do to the Kt/V value?
A. Increases Kt/V
B. No effect
C. Decreases Kt/V
D. Doubles it
➡️ Answer: C. Decreases Kt/V
18. What is the minimum URR target for adequate dialysis according to guidelines?
A. 55%
B. 60%
C. 65%
D. 70%
➡️ Answer: C. 65%
19. Which of the following patient conditions could cause an inaccurate V estimation in Kt/V?
A. Stable dry weight
B. Morbid obesity or cachexia
C. Normal hydration
D. High serum albumin
➡️ Answer: B. Morbid obesity or cachexia
(Because TBW does not increase proportionally with weight in fat tissue)
20. A patient has a low Kt/V but normal URR. What could this indicate?
A. True inadequate dialysis
B. Blood drawn too soon
C. Inaccurate V calculation
D. Both B and C
➡️ Answer: D. Both B and C
✅ Pre & Post Dialysis Urea Sampling – MCQ (Set 1)
1. When should the pre-dialysis blood urea (BUN) sample be collected?
A. After heparin is given
B. Immediately before starting dialysis
C. One hour before dialysis
D. During the first 10 minutes of dialysis
➡️ Answer: B. Immediately before starting dialysis
2. Where should the pre-dialysis sample be drawn from?
A. Venous bloodline after dialysis starts
B. Arterial bloodline before dialysis starts
C. Patient's peripheral vein
D. Dialysate port
➡️ Answer: B. Arterial bloodline before dialysis starts
A. Immediately after stopping blood pump
B. 15 minutes after dialysis session
C. Stop blood pump, wait 15–20 seconds, then draw from arterial line
D. From venous line immediately after treatment
➡️ Answer: C. Stop blood pump, wait 15–20 seconds, then draw from arterial line
(“Stop pump” method is preferred)
4. Which method ensures an accurate post-dialysis BUN sample?
A. Saline-flush method
B. Slow-flow method
C. Mid-dialysis sampling
D. From venous chamber
➡️ Answer: B. Slow-flow method (alternative to stop-pump method)
5. Why must the blood pump be stopped before taking post-dialysis urea?
A. To prevent blood clotting
B. To prevent mixing of recirculated blood
C. To reduce potassium levels
D. To increase accuracy of sodium measurement
➡️ Answer: B. To prevent mixing of recirculated blood
6. Which of the following can falsely lower post-dialysis urea?
A. Drawing sample too early after stopping pump
B. Waiting 30 seconds before sampling
C. Using stop-pump method
D. Proper slow-flow technique
➡️ Answer: A. Drawing sample too early after stopping pump
7. Why is it important not to draw the post-BUN sample immediately after dialysis ends?
A. The urea level may still be rising
B. Dialysis is still removing potassium
C. Recirculation and access dilution may give false reading
D. It causes hemolysis
➡️ Answer: C. Recirculation and access dilution may give false reading
8. If using the "slow-flow" method for post-dialysis BUN, how long should the blood pump run and at what speed before sampling?
A. 10 mL/min for 1 minute
B. 50 mL/min for 15 seconds
C. 100 mL/min for 30 seconds
D. 300 mL/min for 2 minutes
➡️ Answer: A. 10 mL/min for 1 minute
9. Which guideline outlines correct procedures for urea sampling in hemodialysis?
A. WHO Infection Control Guidelines
B. KDIGO Mineral Guidelines
C. KDOQI Clinical Practice Guidelines
D. CDC Dialysis Water Treatment Protocol
➡️ Answer: C. KDOQI Clinical Practice Guidelines
10. Improper post-BUN sampling can result in:
A. Elevated serum potassium
B. Incorrect dry weight calculation
C. Overestimation of Kt/V or URR
D. Underestimation of fluid overload
➡️ Answer: C. Overestimation of Kt/V or URR
11. Which factor has the greatest impact on post-dialysis urea sampling accuracy?
A. Room temperature
B. Dialysate conductivity
C. Recirculation of blood at end of session
D. Anticoagulation dose
➡️ Answer: C. Recirculation of blood at end of session
12. What is the main reason for waiting 15–30 seconds after stopping the blood pump before drawing the post-BUN sample?
A. Allow pressure equalization
B. Prevent clotting
C. Reduce urea rebound
D. Allow access line to clear non-dialyzed blood
➡️ Answer: D. Allow access line to clear non-dialyzed blood
13. What does drawing a post-dialysis sample too late (e.g., >2 min after stopping) risk?
A. Underestimation of dialysis dose (Kt/V)
B. Overestimation of serum sodium
C. False potassium rise
D. Incorrect fluid balance estimation
➡️ Answer: A. Underestimation of dialysis dose (Kt/V)
(due to urea rebound into circulation)
14. Which of the following is not a recommended site for post-BUN sampling?
A. Arterial bloodline after 15 seconds stop-pump
B. Venous needle site
C. Arterial bloodline using slow-flow
D. Needle inserted into arterial tubing after dialysis
➡️ Answer: B. Venous needle site
15. What is the purpose of "urea rebound" consideration in adequacy calculations?
A. It measures serum potassium recovery
B. It ensures clearance of uremic toxins
C. It prevents overestimation of clearance
D. It tracks fluid overload
➡️ Answer: C. It prevents overestimation of clearance
16. The most accurate timing for drawing a pre-BUN sample is:
A. After the start of dialysis pump
B. Before connecting the dialyzer to bloodlines
C. Just before heparin administration
D. Just before starting dialysis blood pump
➡️ Answer: D. Just before starting dialysis blood pump
17. If a blood sample is taken from the venous line post-dialysis, it may:
A. Be more accurate
B. Contain recirculated dialyzed blood
C. Reflect arterial pressure
D. Show higher phosphorus levels
➡️ Answer: B. Contain recirculated dialyzed blood
18. The term "urea kinetic modeling" refers to:
A. Urea measurement in dialysate
B. Use of urea data to assess dialysis dose (Kt/V)
C. Real-time potassium tracking
D. Tracking urine output changes
➡️ Answer: B. Use of urea data to assess dialysis dose (Kt/V)
19. What is the danger of not documenting the method of BUN sampling?
A. Hemolysis
B. Inability to trend Hb levels
C. Misinterpretation of dialysis adequacy
D. Failure to monitor phosphorus
➡️ Answer: C. Misinterpretation of dialysis adequacy
20. According to KDOQI, what is the acceptable Kt/V target for adequate dialysis (3x/week)?
A. ≥0.9
B. ≥1.0
C. ≥1.2
D. ≥1.4
➡️ Answer: C. ≥1.2
✅ Urea Kinetic Modeling & Kt/V Interpretation – MCQ (Set 1)
1. What does the term Kt/V represent in dialysis adequacy?
A. Kidney clearance rate over 24 hours
B. Volume of blood dialyzed per hour
C. Urea clearance × time / volume of distribution
D. Total water loss per session
➡️ Answer: C. Urea clearance × time / volume of distribution
2. In the formula Kt/V, “K” refers to:
A. Potassium removal
B. Blood flow rate
C. Dialyzer urea clearance per minute
D. Volume of ultrafiltration
➡️ Answer: C. Dialyzer urea clearance per minute
3. A Kt/V value of 1.2 in thrice-weekly dialysis is considered:
A. Inadequate
B. Borderline
C. Adequate
D. Excessive
➡️ Answer: C. Adequate
(as per KDOQI guidelines)
4. A low Kt/V (<1.0) most commonly indicates:
A. High urea rebound
B. Overhydration
C. Inadequate dialysis dose
D. Elevated hemoglobin
➡️ Answer: C. Inadequate dialysis dose
5. What can falsely elevate the calculated Kt/V?
A. High pre-BUN level
B. Improper post-BUN sampling (early draw)
C. High fluid removal
D. High serum phosphorus
➡️ Answer: B. Improper post-BUN sampling (early draw)
6. Which of the following factors can lead to a low delivered Kt/V?
A. Longer dialysis duration
B. Higher blood flow rate
C. Shorter dialysis time or session interruption
D. Accurate sampling
➡️ Answer: C. Shorter dialysis time or session interruption
7. The “V” in Kt/V stands for:
A. Blood volume removed
B. Total body water (urea distribution volume)
C. Volume of ultrafiltrate
D. Vascular access volume
➡️ Answer: B. Total body water (urea distribution volume)
8. Which urea kinetic model accounts for rebound after dialysis?
A. Single-pool Kt/V (spKt/V)
B. Double-pool Kt/V (eKt/V)
C. Instantaneous clearance model
D. URR method
➡️ Answer: B. Double-pool Kt/V (eKt/V)
9. Which of the following corresponds to URR (Urea Reduction Ratio) calculation?
A. Pre-BUN / Post-BUN
B. (Pre-BUN − Post-BUN) ÷ Pre-BUN × 100
C. K × t
D. Clearance ÷ total water
➡️ Answer: B. (Pre-BUN − Post-BUN) ÷ Pre-BUN × 100
10. What is the minimum recommended URR value for adequate dialysis (3x/week)?
A. 55%
B. 60%
C. 65%
D. 70%
➡️ Answer: D. 70%
11. Which of the following most accurately reflects urea clearance including urea rebound?
A. spKt/V
B. eKt/V
C. URR
D. URT
➡️ Answer: B. eKt/V (equilibrated Kt/V)
12. In clinical practice, the eKt/V value is generally:
A. Higher than spKt/V
B. Equal to spKt/V
C. Lower than spKt/V
D. Irrelevant to treatment
➡️ Answer: C. Lower than spKt/V
(due to accounting for post-dialysis rebound)
13. URR is less reliable than Kt/V because:
A. It doesn’t account for patient weight
B. It ignores urea distribution volume and rebound
C. It requires multiple blood samples
D. It’s influenced by dialysate sodium
➡️ Answer: B. It ignores urea distribution volume and rebound
14. What could cause a Kt/V of <1.0 despite 4 hours of dialysis?
A. Use of high-flux dialyzer
B. Large urea distribution volume (e.g., obesity)
C. Increased dry weight
D. Low potassium clearance
➡️ Answer: B. Large urea distribution volume (e.g., obesity)
15. In a female patient weighing 50 kg, a Kt/V of 1.0 may be:
A. Overestimated due to small body water volume
B. Underestimated due to sampling error
C. Equal to URR
D. Invalid
➡️ Answer: A. Overestimated due to small body water volume
16. How can increasing dialyzer surface area affect Kt/V?
A. It reduces urea rebound
B. It increases “K” → improving Kt/V
C. It decreases blood volume
D. It causes more fluid shifts
➡️ Answer: B. It increases “K” → improving Kt/V
17. If a dialysis patient has a high URR but low Kt/V, what should be suspected?
A. Sample drawn too late
B. Incorrect dry weight
C. Technical calculation error
D. Small V (body water estimate)
➡️ Answer: D. Small V (body water estimate)
18. What is the most practical way to improve a patient’s Kt/V?
A. Increase dry weight
B. Decrease dialysate flow
C. Increase dialysis time or frequency
D. Use lower dialyzer surface area
➡️ Answer: C. Increase dialysis time or frequency
19. Kt/V is least useful in which dialysis method?
A. Conventional hemodialysis
B. Nocturnal home dialysis
C. CAPD (Continuous Ambulatory Peritoneal Dialysis)
D. In-center hemodialysis
➡️ Answer: C. CAPD
(Kt/V is used, but with different standards in PD)
20. Which parameter can be adjusted directly to improve Kt/V during a single session?
A. Patient weight
B. Dialysis session duration
C. Hemoglobin
D. Predialysis potassium
➡️ Answer: B. Dialysis session duration
✅ Dialysis Adequacy – MCQs (Set 1)
1. Which of the following is the most commonly used measure of dialysis adequacy in hemodialysis?
A. GFR
B. Serum creatinine
C. Kt/V
D. Ultrafiltration volume
➡️ Answer: C. Kt/V
2. According to KDOQI guidelines, the minimum spKt/V target per session for thrice-weekly hemodialysis should be:
A. 1.0
B. 1.2
C. 1.5
D. 1.8
➡️ Answer: B. 1.2
3. The Urea Reduction Ratio (URR) is calculated using which formula?
A. (Post BUN − Pre BUN) / Pre BUN × 100
B. (Pre BUN − Post BUN) / Pre BUN × 100
C. (Pre BUN + Post BUN) / 2
D. Post BUN / Pre BUN
➡️ Answer: B. (Pre BUN − Post BUN) / Pre BUN × 100
4. An acceptable URR value indicating adequate dialysis is:
A. >50%
B. >60%
C. >65%
D. >70%
➡️ Answer: D. >70%
5. Which of the following factors will not directly affect dialysis adequacy (Kt/V)?
A. Dialyzer membrane surface area
B. Dialysis session duration
C. Patient’s hemoglobin level
D. Blood flow rate
➡️ Answer: C. Patient’s hemoglobin level
6. Which component of Kt/V refers to total body water as a distribution volume for urea?
A. K
B. t
C. V
D. sp
➡️ Answer: C. V
7. A lower-than-target Kt/V may result from all the following except:
A. Frequent interruptions during dialysis
B. Low blood flow rate
C. Large volume of distribution (obesity)
D. High dialysate sodium
➡️ Answer: D. High dialysate sodium
8. The most effective strategy to improve dialysis adequacy in a patient with low Kt/V is:
A. Increase dry weight
B. Reduce dialysate temperature
C. Increase session duration or frequency
D. Decrease dialysate flow
➡️ Answer: C. Increase session duration or frequency
✅ Improving Adequacy of Hemodialysis – MCQs
1. Which of the following interventions is the MOST effective in improving dialysis adequacy (Kt/V)?
A. Reducing dialysate temperature
B. Shortening dialysis time
C. Increasing blood flow rate and treatment time
D. Using a small dialyzer
➡️ Answer: C. Increasing blood flow rate and treatment time
2. A patient has low Kt/V despite standard dialysis parameters. Which is the first parameter to evaluate?
A. Dry weight
B. Type of anticoagulant
C. Vascular access function and blood flow
D. Post-dialysis weight gain
➡️ Answer: C. Vascular access function and blood flow
3. What is the preferred type of vascular access for optimal adequacy in hemodialysis?
A. Double-lumen catheter
B. AV graft
C. AV fistula
D. Peritoneal catheter
➡️ Answer: C. AV fistula
4. What is a recommended dialyzer characteristic to improve solute clearance?
A. Low flux, low surface area
B. High flux, high surface area
C. Low ultrafiltration coefficient
D. Small membrane size
➡️ Answer: B. High flux, high surface area
5. In which situation is increased dialysis frequency most appropriate to improve adequacy?
A. Patient with good residual renal function
B. Obese patient with large V (urea distribution volume)
C. Patient with low ultrafiltration need
D. Stable patient with no comorbidities
➡️ Answer: B. Obese patient with large V (urea distribution volume)
6. What is the recommended minimum duration for a standard HD session (thrice weekly) to ensure adequacy?
A. 2 hours
B. 2.5 hours
C. 3 hours
D. 4 hours
➡️ Answer: D. 4 hours
7. A patient has low Kt/V due to high post-dialysis rebound. What may help reduce rebound and improve adequacy?
A. Use low-efficiency dialyzer
B. Shorten dialysis session
C. Use slow-dialysis termination techniques
D. Reduce dialysate flow
➡️ Answer: C. Use slow-dialysis termination techniques
8. One method to monitor whether poor dialysis adequacy is due to access recirculation is to:
A. Measure pre- and post-BUN only
B. Perform access flow studies or urea-based recirculation test
C. Increase dialysate conductivity
D. Decrease session frequency
➡️ Answer: B. Perform access flow studies or urea-based recirculation test
9. The most effective way to improve small-solute clearance during HD is to:
A. Use dialysate with low sodium
B. Increase dialysate calcium
C. Increase dialyzer surface area and session time
D. Use heparin bolus
➡️ Answer: C. Increase dialyzer surface area and session time
10. Which of the following is NOT an appropriate strategy to improve dialysis adequacy?
A. Increase dialysis time
B. Improve vascular access function
C. Increase patient weight gain
D. Increase dialysate and blood flow rates
➡️ Answer: C. Increase patient weight gain
11. Which factor has the GREATEST impact on improving clearance during hemodialysis?
A. Dialysate potassium concentration
B. Dialyzer reuse frequency
C. Blood flow rate
D. Patient’s interdialytic weight gain
➡️ Answer: C. Blood flow rate
12. Which of the following indicates that the dialyzer performance may be declining over time?
A. High post-dialysis urea
B. Increased URR
C. Higher hemoglobin
D. Low phosphorus
➡️ Answer: A. High post-dialysis urea
13. What blood flow rate (Qb) is typically required for optimal dialysis adequacy?
A. 100–150 mL/min
B. 150–200 mL/min
C. 200–250 mL/min
D. ≥300 mL/min
➡️ Answer: D. ≥300 mL/min
14. A persistently low Kt/V despite increased dialysis time suggests:
A. Overhydration
B. High protein intake
C. Access recirculation or poor blood flow
D. Low ultrafiltration
➡️ Answer: C. Access recirculation or poor blood flow
15. If dialysate flow (Qd) is increased from 500 to 800 mL/min, what is the expected effect?
A. No change in clearance
B. Decreased clearance
C. Improved clearance
D. Increased clotting
➡️ Answer: C. Improved clearance
16. Inadequate dialysis due to access issues is best resolved by:
A. Changing dialysate sodium
B. Flushing the dialyzer
C. Referring for access evaluation/intervention
D. Increasing ultrafiltration rate
➡️ Answer: C. Referring for access evaluation/intervention
17. Which intervention is LEAST likely to improve Kt/V?
A. Increasing treatment frequency
B. Switching from catheter to AVF
C. Lowering dialysate temperature
D. Using high-efficiency dialyzer
➡️ Answer: C. Lowering dialysate temperature
18. In which of the following patients would a standard 4-hour HD session likely result in low adequacy?
A. Small body size, good access
B. Anuric patient with low weight
C. Large body mass with high urea distribution volume (V)
D. Diabetic patient with AV fistula
➡️ Answer: C. Large body mass with high urea distribution volume (V)
.19. How can high urea rebound be minimized?
A. Give heparin bolus
B. Extend treatment time and slow down end-of-dialysis clearance
C. Use high-sodium dialysate
D. Give bolus saline before post-BUN
➡️ Answer: B. Extend treatment time and slow down end-of-dialysis clearance
20. Improving dialysis adequacy in a patient with poor compliance can best be achieved by:
A. Encouraging session completion and adherence
B. Increasing blood pressure meds
C. Lowering dialysate flow
D. Reducing session frequency
➡️ Answer: A. Encouraging session completion and adherence
✅ Hemodialysis Adequacy – MCQs
1. What does Kt/V represent in hemodialysis adequacy measurement?
A. Kidney function over time
B. Dialyzer urea clearance
C. Urea clearance normalized to body water volume
D. Time spent on dialysis per session
➡️ Answer: C. Urea clearance normalized to body water volume
2. What is the minimum Kt/V target recommended by KDOQI for thrice-weekly dialysis?
A. 0.9
B. 1.0
C. 1.2
D. 1.8
➡️ Answer: C. 1.2
3. A dialysis patient has a Kt/V of 0.9. This indicates:
A. Adequate dialysis
B. Excellent dialysis
C. Inadequate dialysis
D. Residual renal function is high
➡️ Answer: C. Inadequate dialysis
4. Which of the following is commonly used as a secondary measure of dialysis adequacy?
A. Hematocrit
B. Serum creatinine
C. URR (Urea Reduction Ratio)
D. Ultrafiltration volume
➡️ Answer: C. URR (Urea Reduction Ratio)
5. A URR value of 65% means:
A. Urea increased by 65%
B. Urea decreased by 65%
C. Kt/V = 2.5
D. Dialysis was ineffective
➡️ Answer: B. Urea decreased by 65%
6. What is the acceptable URR target per KDOQI guidelines?
A. <50%
B. ≥60%
C. 40–55%
D. ≥75%
➡️ Answer: B. ≥60%
7. Pre- and post-dialysis urea samples should be collected:
A. Immediately after dialysis starts and ends
B. Pre: before heparin; Post: slow flow, no ultrafiltration
C. During dialysis
D. 30 minutes post dialysis
➡️ Answer: B. Pre: before heparin; Post: slow flow, no ultrafiltration
8. Which parameter is used in the calculation of Kt/V?
A. Hemoglobin level
B. Patient’s height only
C. Total body water (V)
D. Serum calcium
➡️ Answer: C. Total body water (V)
9. Which of the following can falsely elevate Kt/V results?
A. Inadequate urea sampling
B. High ultrafiltration rate
C. Hypotension
D. Recirculation in access
➡️ Answer: A. Inadequate urea sampling
10. In patients with residual renal function, adequacy targets:
A. Are not needed
B. Should be higher
C. May allow for lower Kt/V
D. Should be based on creatinine alone
➡️ Answer: C. May allow for lower Kt/V
11. A Kt/V of 0.95 in a patient receiving thrice-weekly dialysis suggests:
A. Excellent dialysis adequacy
B. Below recommended target
C. Normal for patients with residual urine output
D. Likely overestimated due to dry weight
➡️ Answer: B. Below recommended target
12. Which of the following would most likely INCREASE dialysis adequacy?
A. Reducing blood flow rate
B. Increasing session time
C. Increasing dialysate sodium
D. Decreasing dialyzer surface area
➡️ Answer: B. Increasing session time
13. The main reason to slow blood pump speed during post-dialysis BUN sampling is to:
A. Reduce ultrafiltration
B. Get arterial blood sample without recirculation
C. Prevent hypotension
D. Flush heparin
➡️ Answer: B. Get arterial blood sample without recirculation
14. Which of the following patient characteristics affects the “V” in Kt/V?
A. Blood urea nitrogen
B. Dialyzer clearance
C. Total body water
D. Blood pressure
➡️ Answer: C. Total body water
15. Which type of vascular access is most associated with LOW Kt/V due to recirculation?
A. Arteriovenous fistula
B. Arteriovenous graft
C. Central venous catheter
D. Buttonhole cannulation
➡️ Answer: C. Central venous catheter
16. Which scenario best reflects adequate dialysis per KDOQI guidelines?
A. Kt/V = 1.0, URR = 50%
B. Kt/V = 1.2, URR = 65%
C. Kt/V = 0.9, URR = 60%
D. Kt/V = 1.4, URR = 50%
➡️ Answer: B. Kt/V = 1.2, URR = 65%
17. High ultrafiltration rate may affect adequacy by:
A. Increasing total urea removed
B. Causing premature termination due to hypotension
C. Improving blood flow
D. Lowering recirculation
➡️ Answer: B. Causing premature termination due to hypotension
18. In which of the following is it most important to monitor Kt/V trends closely?
A. Patient with AVF and good dry weight
B. Patient with catheter and poor compliance
C. Patient with low serum calcium
D. Patient with residual urine >1 L/day
➡️ Answer: B. Patient with catheter and poor compliance
19. Which of the following improves adequacy in high BMI patients?
A. Reducing dialysate flow
B. Shortening session time
C. High-efficiency dialyzer use
D. Reducing blood flow rate
➡️ Answer: C. High-efficiency dialyzer use
20. A persistent low Kt/V in a compliant patient should prompt:
A. Increase dialysate potassium
B. Investigate access dysfunction
C. Stop one dialysis session per week
D. Reduce fluid intake
➡️ Answer: B. Investigate access dysfunction
7.KDOQI-Hemodialysis Dose
✅ KDOQI – Hemodialysis Dose MCQs
1. According to KDOQI, the recommended minimum single-pool Kt/V per dialysis session is:
A. 1.0
B. 1.2
C. 1.5
D. 2.0
➡️ Answer: B. 1.2
2. For patients receiving thrice-weekly hemodialysis, KDOQI recommends a URR of at least:
A. 50%
B. 55%
C. 60%
D. 70%
➡️ Answer: C. 60%
3. What does the "K" in Kt/V stand for in the context of dialysis dose?
A. Kinetic rate of urea removal
B. Dialyzer clearance of urea
C. Potassium removal
D. Kidney filtration rate
➡️ Answer: B. Dialyzer clearance of urea
4. According to KDOQI, how often should the dialysis dose (Kt/V) be assessed in stable patients?
A. Monthly
B. Weekly
C. Every 3 months
D. Every dialysis session
➡️ Answer: A. Monthly
5. If a patient's spKt/V is consistently below 1.2, the KDOQI guideline suggests:
A. Reducing session time
B. Increasing blood flow and/or session length
C. Skipping dialysis sessions
D. Increasing sodium in dialysate
➡️ Answer: B. Increasing blood flow and/or session length
6. For hemodialysis patients with residual renal function, KDOQI suggests adequacy can be achieved with:
A. Only peritoneal dialysis
B. Thrice-weekly dialysis regardless of residual function
C. Twice-weekly dialysis with total (dialysis + residual) Kt/V ≥ 2.0
D. Dialysis discontinued
➡️ Answer: C. Twice-weekly dialysis with total (dialysis + residual) Kt/V ≥ 2.0
7. Which method does KDOQI prefer for routine monitoring of dialysis adequacy?
A. Blood pressure and weight loss
B. URR (Urea Reduction Ratio)
C. Clinical symptoms only
D. Single-pool Kt/V (spKt/V)
➡️ Answer: D. Single-pool Kt/V (spKt/V)
8. Which KDOQI guideline applies when interpreting low Kt/V in a patient with good compliance?
A. Increase dry weight
B. Assess for access recirculation or dialyzer performance
C. Decrease session duration
D. Stop URR monitoring
➡️ Answer: B. Assess for access recirculation or dialyzer performance
9. Which of the following is a goal, not a minimum standard, per KDOQI guidelines for Kt/V?
A. spKt/V ≥ 1.2
B. URR ≥ 65%
C. spKt/V ≥ 1.4
D. Weekly Kt/V = 3.5
➡️ Answer: C. spKt/V ≥ 1.4
10. KDOQI recommends total weekly Kt/V urea should be at least what for patients on frequent daily HD?
A. ≥3.0
B. ≥4.0
C. ≥2.5
D. ≥6.0
➡️ Answer: A. ≥3.0
11. In KDOQI guidelines, which equation is most commonly used to calculate dialysis dose?
A. Cockcroft-Gault
B. Modified Daugirdas formula
C. MDRD
D. Fick’s equation
➡️ Answer: B. Modified Daugirdas formula
12. Which patient scenario would require more frequent Kt/V monitoring?
A. Stable patient with AV fistula
B. New dialysis patient or recent access change
C. Patient on home hemodialysis
D. Patient with no symptoms
➡️ Answer: B. New dialysis patient or recent access change
13. According to KDOQI, a significant drop in Kt/V from previous months should prompt:
A. Reschedule of sessions to weekends
B. Repeat measurement in 6 months
C. Evaluation for access dysfunction or treatment errors
D. Discontinue lab tests
➡️ Answer: C. Evaluation for access dysfunction or treatment errors
14. Which of the following affects dialysis dose (Kt/V) the most?
A. Weight before dialysis
B. Dialysate sodium
C. Blood flow rate and session time
D. Dialysate bicarbonate
➡️ Answer: C. Blood flow rate and session time
15. The “V” in Kt/V (total body water) is estimated based on which patient factor?
A. Serum sodium
B. Hemoglobin
C. Weight, height, and sex
D. Blood pressure and glucose
➡️ Answer: C. Weight, height, and sex
16. What is a common cause of falsely elevated Kt/V?
A. Dehydrated patient
B. Long sampling time after session
C. Recirculation during blood sampling
D. Poor dialyzer function
➡️ Answer: B. Long sampling time after session
17. When calculating URR, a patient’s pre-BUN is 70 mg/dL and post-BUN is 28 mg/dL. What is the URR?
A. 60%
B. 50%
C. 65%
D. 40%
➡️ Answer: A. 60%
🧮 URR = (Pre - Post) / Pre = (70 - 28) / 70 = 42/70 ≈ 60%
18. Which action should be taken if monthly Kt/V is 1.0 for 3 consecutive months?
A. Stop blood tests
B. Increase dialyzer surface area or session length
C. Start erythropoietin
D. Decrease dialysate flow
➡️ Answer: B. Increase dialyzer surface area or session length
19. In home nocturnal hemodialysis (6–8 hours, 5–6 nights/week), the expected weekly Kt/V is typically:
A. <3.0
B. 3.0–4.0
C. 4.5–6.0
D. >7.0
➡️ Answer: C. 4.5–6.0
20. KDOQI recommends an individualized dialysis prescription considering all except:
A. Patient's total body water
B. Residual kidney function
C. Pre-dialysis blood glucose
D. Patient treatment goals
➡️ Answer: C. Pre-dialysis blood glucose
8.IS Kt/V the Best Measure of Dialysis Adequacy
✅ MCQs: Is Kt/V the Best Measure of Dialysis Adequacy?
1. Which of the following is the most commonly used parameter to measure dialysis adequacy?
A. URR (Urea Reduction Ratio)
B. Creatinine clearance
C. Kt/V
D. Serum albumin
➡️ Answer: C. Kt/V
2. Kt/V primarily measures the clearance of which solute?
A. Creatinine
B. Potassium
C. Phosphate
D. Urea
➡️ Answer: D. Urea
3. A key limitation of using Kt/V alone to assess adequacy is:
A. It cannot be calculated without a dialyzer
B. It does not account for symptoms or volume control
C. It is only used in peritoneal dialysis
D. It overestimates dialysis dose in all patients
➡️ Answer: B. It does not account for symptoms or volume control
4. Which patient group may have misleadingly low Kt/V despite adequate dialysis?
A. Patients with low muscle mass
B. Patients with diabetes
C. Elderly patients with dry weight issues
D. Patients with fluid overload
➡️ Answer: A. Patients with low muscle mass
5. Which of the following is NOT reflected by Kt/V?
A. Volume status
B. Urea clearance
C. Treatment time
D. Blood flow rate
➡️ Answer: A. Volume status
6. Which parameter, when combined with Kt/V, gives a better clinical picture of dialysis adequacy?
A. Hematocrit
B. Albumin
C. Phosphate and blood pressure control
D. Hemoglobin A1c
➡️ Answer: C. Phosphate and blood pressure control
7. Which of the following is TRUE regarding Kt/V?
A. It accounts for uremic toxin clearance of all molecular weights
B. It directly measures patient outcomes like survival
C. It is a surrogate marker, not a direct outcome measure
D. It measures potassium and sodium clearance equally
➡️ Answer: C. It is a surrogate marker, not a direct outcome measure
8. A patient has high Kt/V but poor appetite, anemia, and fluid overload. This suggests:
A. Dialysis adequacy is excellent
B. Kt/V is the only marker needed
C. Kt/V alone may not reflect true clinical adequacy
D. The patient should skip sessions
➡️ Answer: C. Kt/V alone may not reflect true clinical adequacy
9. Why might clinicians use standardized Kt/V (stdKt/V) in addition to single-pool Kt/V?
A. It's easier to calculate
B. It reflects urea clearance over a week, including frequency
C. It is used only for peritoneal dialysis
D. It is measured without lab tests
➡️ Answer: B. It reflects urea clearance over a week, including frequency
10. Which of the following is increasingly recognized as a complementary indicator of dialysis adequacy besides Kt/V?
A. Blood glucose level
B. Patient-reported quality of life
C. Hemoglobin A1c
D. Total cholesterol
➡️ Answer: B. Patient-reported quality of life
11. What is one major concern about relying solely on Kt/V in dialysis prescription?
A. It may lead to overestimation of calcium levels
B. It can ignore patient-centered outcomes
C. It measures only glucose clearance
D. It prevents dry weight assessment
➡️ Answer: B. It can ignore patient-centered outcomes
12. Kt/V does not reliably reflect removal of:
A. Urea
B. Sodium
C. Beta-2 microglobulin and middle molecules
D. Bicarbonate
➡️ Answer: C. Beta-2 microglobulin and middle molecules
13. Which of the following would indicate a patient has adequate Kt/V but still poor dialysis outcomes?
A. High hemoglobin and high albumin
B. Stable weight and good appetite
C. Recurrent hospitalizations and poor functional status
D. High phosphate with low protein intake
➡️ Answer: C. Recurrent hospitalizations and poor functional status
14. Which type of Kt/V measurement includes urea generation between sessions?
A. Single-pool Kt/V
B. Double-pool Kt/V
C. Instantaneous Kt/V
D. Standardized Kt/V (stdKt/V)
➡️ Answer: D. Standardized Kt/V (stdKt/V)
15. What aspect of dialysis does Kt/V completely ignore?
A. Clearance rate of urea
B. Dialyzer performance
C. Ultrafiltration (fluid removal)
D. Blood flow rate
➡️ Answer: C. Ultrafiltration (fluid removal)
16. Which outcome is most strongly associated with better overall patient survival in hemodialysis, beyond Kt/V?
A. Serum creatinine
B. Nutritional status and inflammation control
C. Dialyzer membrane size
D. Use of reuse policy
➡️ Answer: B. Nutritional status and inflammation control
17. Why is Kt/V not ideal for comparing patients on different dialysis schedules (e.g., daily vs. thrice weekly)?
A. Because urea is not removed in daily dialysis
B. Because it does not adjust for frequency of sessions
C. Because Kt/V uses different solutes
D. It cannot be measured more than once a month
➡️ Answer: B. Because it does not adjust for frequency of sessions
18. Which parameter is now often used in research and high-frequency dialysis to standardize adequacy?
A. eKt/V
B. URR
C. stdKt/V
D. Serum potassium
➡️ Answer: C. stdKt/V (standardized Kt/V)
19. A patient has a high Kt/V but elevated phosphorus and low serum albumin. What does this indicate?
A. Excellent dialysis adequacy
B. Low potassium intake
C. Incomplete dialysis adequacy picture
D. High ultrafiltration rate
➡️ Answer: C. Incomplete dialysis adequacy picture
**20. According to current evidence, Kt/V is most useful when:
A. Used as the sole metric for adequacy
B. Interpreted with patient symptoms, labs, and fluid status
C. Used for determining potassium dose
D. Interpreted monthly only
➡️ Answer: B. Interpreted with patient symptoms, labs, and fluid status
9.How To Prescribe KT/V > 1.3
✅ MCQs: How to Prescribe Kt/V > 1.3
1. What is the minimum target single-pool Kt/V (spKt/V) recommended by KDOQI for thrice-weekly hemodialysis?
A. 1.0
B. 1.2
C. 1.3
D. 1.5
➡️ Answer: C. 1.3
2. Which of the following changes is most effective in increasing Kt/V?
A. Reducing dialyzer surface area
B. Increasing dialysate temperature
C. Increasing dialysis session duration
D. Lowering blood flow rate
➡️ Answer: C. Increasing dialysis session duration
3. If a patient’s Kt/V is 1.0, which adjustment would most likely help achieve >1.3?
A. Decreasing treatment time from 4 to 3 hours
B. Increasing blood flow from 300 to 400 mL/min
C. Reducing dialysate flow
D. Lowering dialyzer efficiency
➡️ Answer: B. Increasing blood flow from 300 to 400 mL/min
4. What role does the dialyzer play in achieving adequate Kt/V?
A. Its color determines adequacy
B. Surface area and membrane type affect solute clearance
C. It only removes fluids
D. It lowers hemoglobin
➡️ Answer: B. Surface area and membrane type affect solute clearance
5. Which of the following will decrease Kt/V if not properly managed?
A. Infiltrated vascular access with poor blood flow
B. Longer treatment time
C. High-efficiency dialyzer
D. High blood pump speed
➡️ Answer: A. Infiltrated vascular access with poor blood flow
6. A patient receives 3-hour sessions and has Kt/V of 1.1. What’s a reasonable next step to improve Kt/V?
A. Shorten sessions to 2.5 hours
B. Increase frequency to 4x/week
C. Reduce dialysate flow rate
D. Keep treatment unchanged
➡️ Answer: B. Increase frequency to 4x/week
7. Which component in the Kt/V formula is most affected by the duration of dialysis?
A. K (clearance)
B. t (time)
C. V (volume of distribution)
D. Dialysate sodium
➡️ Answer: B. t (time)
8. Which patient factor can reduce the effective Kt/V despite adequate treatment prescription?
A. Low serum urea
B. Large total body water volume (V)
C. High dialysate flow
D. Small dialyzer size
➡️ Answer: B. Large total body water volume (V)
9. In order to prescribe a Kt/V >1.3, which strategy is most comprehensive?
A. Just increase the dialysate flow
B. Use low-flux dialyzer with longer time
C. Optimize time, blood flow, dialyzer, and vascular access
D. Use normal saline before sample
➡️ Answer: C. Optimize time, blood flow, dialyzer, and vascular access
10. Which action could result in an inaccurately low post-urea sample, thus underestimating Kt/V?
A. Waiting 2 minutes after slowing pump to draw sample
B. Drawing sample immediately from arterial line
C. Slowing pump to 100 mL/min and waiting 15 seconds
D. Drawing from venous line post-treatment
➡️ Answer: B. Drawing sample immediately from arterial line
10.How to Prescribe KT/V > 1.3
✅ MCQs: How to Prescribe Kt/V > 1.3 (Set 2)
11. A patient consistently has Kt/V of 1.1 despite 4-hour treatments. What might be the cause?
A. Very small body size
B. High blood flow rate
C. Underestimation of total body water (V)
D. Recirculation from poor vascular access
➡️ Answer: D. Recirculation from poor vascular access
12. Increasing the dialysis frequency from 3x/week to 4x/week generally has what effect on Kt/V?
A. Decreases Kt/V
B. Increases Kt/V
C. No effect
D. Affects potassium levels only
➡️ Answer: B. Increases Kt/V
13. The "V" in the Kt/V formula stands for:
A. Volume of blood filtered
B. Vascular resistance
C. Volume of urea distribution (total body water)
D. Venous pressure
➡️ Answer: C. Volume of urea distribution (total body water)
14. In terms of optimizing dialysis dose, what is the recommended minimum blood flow rate for adult hemodialysis?
A. 150 mL/min
B. 200 mL/min
C. 250 mL/min
D. 300–400 mL/min
➡️ Answer: D. 300–400 mL/min
15. Which dialyzer characteristic most significantly affects urea clearance?
A. Color of casing
B. Membrane flux and surface area
C. Tubing material
D. Reuse number
➡️ Answer: B. Membrane flux and surface area
16. If a patient's weight increases but dialysis prescription stays the same, what will likely happen to Kt/V?
A. It will increase
B. It will stay the same
C. It will decrease
D. It becomes unmeasurable
➡️ Answer: C. It will decrease
(Because V increases, lowering Kt/V)
17. When drawing a post-dialysis urea sample, which practice helps ensure accurate Kt/V calculation?
A. Immediately stopping the pump and drawing
B. Drawing while the blood pump is still running
C. Slowing the blood pump to 100 mL/min for 15–30 seconds before sampling
D. Drawing from the venous line before rinseback
➡️ Answer: C. Slowing the blood pump to 100 mL/min for 15–30 seconds before sampling
18. Which of the following helps reduce urea rebound, improving accuracy of measured Kt/V?
A. Taking post sample immediately after session
B. Using low-efficiency dialyzer
C. Taking post sample after a brief wait or slow flow period
D. Avoiding urea measurement
➡️ Answer: C. Taking post sample after a brief wait or slow flow period
19. What is an advantage of standardized Kt/V (stdKt/V) over single-pool Kt/V (spKt/V)?
A. Easier to measure
B. Includes residual renal function
C. Reflects frequency and urea generation rate
D. It ignores patient hydration status
➡️ Answer: C. Reflects frequency and urea generation rate
20. If the dialysate flow rate is too low, the impact on Kt/V is likely:
A. Improved clearance
B. No effect
C. Decreased clearance
D. Increased blood volume
➡️ Answer: C. Decreased clearance
11.How To Prescribe KT/V > 1.3
✅ MCQs: How to Prescribe Kt/V > 1.3 (Set 3)
21. Which of the following will NOT help increase Kt/V in a hemodialysis patient?
A. Increasing session duration
B. Increasing blood flow rate
C. Reducing dialyzer surface area
D. Using a high-flux dialyzer
➡️ Answer: C. Reducing dialyzer surface area
22. A patient is receiving high-efficiency dialysis, but Kt/V is low. What should be assessed first?
A. Serum calcium
B. Blood-dialysate leak
C. Vascular access recirculation
D. Alkalosis risk
➡️ Answer: C. Vascular access recirculation
23. What is the recommended minimum treatment time to achieve adequate Kt/V in standard thrice-weekly dialysis?
A. 2 hours
B. 3 hours
C. 3.5 hours
D. 4 hours or more
➡️ Answer: D. 4 hours or more
24. Which strategy helps increase K in the Kt/V formula?
A. Reduce blood pump speed
B. Reduce dialyzer efficiency
C. Use high-efficiency dialyzers and maximize flow rates
D. Decrease ultrafiltration
➡️ Answer: C. Use high-efficiency dialyzers and maximize flow rates
25. What does blood flow rate (Qb) of 350–400 mL/min typically ensure?
A. Improved phosphorus control
B. Optimal bicarbonate diffusion
C. Enhanced solute clearance (urea, toxins)
D. Better iron delivery
➡️ Answer: C. Enhanced solute clearance (urea, toxins)
26. Increasing which of the following has the most direct impact on dialysate-side clearance?
A. Blood flow rate
B. Dialysate flow rate
C. Hematocrit
D. Serum potassium
➡️ Answer: B. Dialysate flow rate
27. Which patient condition may cause overestimation of Kt/V?
A. High serum sodium
B. Severe dehydration
C. High muscle mass
D. Fluid overload (↑ TBW)
➡️ Answer: D. Fluid overload (↑ TBW)
28. What lab trend may suggest under-dialysis despite reported Kt/V > 1.3?
A. Decreasing phosphorus
B. High serum creatinine and worsening fatigue
C. Low albumin
D. Low hemoglobin
➡️ Answer: B. High serum creatinine and worsening fatigue
29. A patient with residual urine output may require a lower dialysis dose. What is this called?
A. Standardized clearance
B. Adjusted URR
C. Residual renal function compensation
D. Integrated dialysis dose
➡️ Answer: C. Residual renal function compensation
30. Which combination most effectively improves spKt/V >1.3 in a patient with poor clearance?
A. Longer sessions + higher Qb + efficient dialyzer
B. Shorter sessions + lower Qb
C. Increased dialysate calcium
D. Frequent use of saline flush
➡️ Answer: A. Longer sessions + higher Qb + efficient dialyzer
