Module 3 — Treatment Options for Kidney Failure

Study guide

• Kidney failure can be treated with a kidney transplant or dialysis; each can sustain life, sometimes for many years. The best option is the one that fits the person’s health, goals, schedule, support, and preferences.Play from here
• This chapter presents nine broad choices: transplant; two PD approaches; standard in-center HD; nocturnal in-center HD; standard home HD; daily home HD; nocturnal home HD; and active medical management without dialysis.Play from here
• The chapter’s central message is autonomy: patients may not realize they have choices or that they can change modalities. Staff should explain options without steering by convenience or fear.Play from here

Why answers are correct

• A technically effective treatment that prevents work, caregiving, sleep, travel, or preferred eating may be a poor life-fit. Matching treatment to what matters can improve engagement and quality of life.Play from here
• Fear and information gaps can make patients think they have no choice. Education, repetition, social-work support, and referral to the home-training nurse or doctor help patients decide.Play from here

Limitations / traps

• Do not promise that one modality is best for everyone or that a patient can automatically qualify for transplant or home therapy.Play from here
• The technician provides accurate, unbiased information within scope; do not diagnose, change a prescription, or answer an uncertain clinical question from memory. Ask the nurse.Play from here

Clinical pearl / safety

• Treat complaints about thirst, diet, fluid gain, long travel, work, childcare, or treatment symptoms as openings to identify a better-fit option—not as evidence of poor motivation.Play from here

Exam cue

• Good modality choice = clinical safety + patient goals + feasible support + informed preference.Play from here

Study guide

• A transplant places one healthy donor kidney in the recipient. The native kidneys generally remain in place; the graft is connected to the iliac vessels and ureter.Play from here
• Transplant is not a cure for kidney failure. A graft may never work or may last years to decades; rejection can occur whenever the immune system attacks it as foreign.Play from here
• The chapter reports better short-term graft survival for living-donor than deceased-donor kidneys (about 98% versus 94% functioning at one year; about 86.5% versus 76% at five years). These are chapter figures, not a guarantee for an individual.Play from here
• Recipients need lifelong immunosuppression while the graft functions. Possible effects include weight gain, stomach irritation, unwanted hair, dyslipidemia, hypertension, cataracts, bone/joint problems, infection, diabetes, and cancer.Play from here
• Transplant patients usually drink more water and have fewer diet limits than people on dialysis. If a graft fails, dialysis can resume and another transplant may be possible.Play from here
• Listing is not automatic. A transplant center evaluates physical and psychological readiness and applies its own rules. OPTN maintains the national deceased-donor list, but the supply is insufficient, so waits may be long.Play from here
• Donor sources:
  1. deceased donor;
  2. living blood relative;
  3. living unrelated donor.
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• Potential living donors need health evaluation and blood/tissue compatibility testing. A kidney-paired exchange can match incompatible donor–recipient pairs with other pairs; an altruistic donor can start a longer chain.Play from here
• Kidney-pancreas (KP) transplant: selected people with diabetes and kidney failure may receive both organs. A simultaneous kidney-pancreas transplant can remove the need for dialysis and insulin while both grafts work. A pancreas graft may improve diabetic injury, but eligibility is program-specific.Play from here
• Preemptive transplant: transplantation before dialysis may be considered when GFR is about 20 or lower; a living donor is often needed because timing is predictable.Play from here
• Matching tools described by the chapter include KDPI, which estimates how long a donated kidney may last from donor characteristics, and EPTS, which estimates recipient post-transplant survival. ABO-incompatible transplant may be possible after immune desensitization.Play from here

Why answers are correct

• Transplant can restore more continuous kidney functions than intermittent dialysis, but it adds surgical risk, immune rejection risk, and medication toxicity. It is a treatment option, not a permanent cure.Play from here
• A donor match is not simply “same blood type”: programs weigh compatibility, expected graft longevity, recipient factors, and safety.Play from here

Limitations / traps

• Never imply that a person is “not trying” because they are not listed; age, comorbidity, psychological evaluation, donor supply, program criteria, and access all matter.Play from here
• Do not tell a patient to stop immunosuppressants or interpret possible rejection. New illness, infection, medication problems, reduced function, or concerning symptoms require the transplant team.Play from here
• Survival percentages are population estimates and may change with era, donor type, and patient selection.Play from here

Clinical pearl / safety

• A patient turned down by one program may be accepted by another because programs use different criteria. Refer questions to the transplant center and social worker rather than closing the door.Play from here

Exam cue

• Transplant = closest available approach to normal kidney function, but not a cure; lifelong immunosuppression and rejection surveillance remain.Play from here

Compare / contrast

Study guide

• During dialysis, a semipermeable membrane separates blood from dialysate. Water and selected wastes cross microscopic pores into dialysate; cleaned blood returns to the patient.Play from here
• Dialysis cannot reproduce all continuous kidney functions. A well-dialyzed person may still need medicines, anemia treatment, vitamin D, phosphate management, and careful fluid/electrolyte planning.Play from here
• Compared with healthy kidneys, dialysis generally removes only some water and wastes on treatment days, helps rather than fully controls electrolyte/acid–base balance and blood pressure, and does not make EPO or activate vitamin D. It can alter calcium and remove some phosphorus but less completely than healthy kidneys.Play from here
• Treatments should be comfortable and leave patients feeling well. Painful cramps, hypotension, repeated symptoms, and treatment-related accidents are common warning findings—not an acceptable goal.Play from here

Why answers are correct

• Healthy kidneys work 24 hours a day, seven days a week. Dialysis dose, frequency, duration, residual kidney function, and modality determine how closely treatment approximates that continuous work.Play from here
• “Dialysis patient” does not mean “unable to work or live normally.” The chapter emphasizes energy, appetite, sleep, intimacy, blood pressure, target labs, and healthy heart/bones as reasonable goals.Play from here

Limitations / traps

• Do not equate a completed treatment with full kidney replacement. Missed or shortened treatments reduce delivered clearance and increase fluid/waste exposure.Play from here
• Do not normalize cramps, hypotension, or feeling ill after every treatment; assess, protect, and report.Play from here

Clinical pearl / safety

• During or after treatment, observe symptoms and vital signs, check the system/access according to policy, notify the nurse promptly, and document accurately.Play from here

Exam cue

• Dialysis removes selected substances across a membrane; it does not replace every renal endocrine and regulatory function.Play from here

Compare / contrast: healthy kidneys and dialysis

Study guide

• The seven dialysis approaches listed are:
  1. hand PD at home or work (CAPD);
  2. cycler PD at night (CCPD/APD);
  3. standard in-center HD;
  4. nocturnal in-center HD;
  5. standard home HD;
  6. daily home HD;
  7. nocturnal home HD.
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• Ask what the patient values: keeping a job or school, caregiving, travel, eating and drinking flexibility, avoiding needles, sleeping, treatment privacy, proximity to a clinic, and available partner/space.Play from here
• Home options require training and a safe setup; they are not automatically easy. In-center options provide staff and supplies but impose clinic schedules and travel.Play from here
• The chapter points to the free My Kidney Life Plan decision aid from the Medical Education Institute and to home-dialysis education resources.Play from here

Why answers are correct

• The same modality can be helpful for one patient and burdensome for another. A person who gains fluid, travels far, works nights, or cares for children may benefit from a different schedule or home option.Play from here

Limitations / traps

• Never scare patients away from home therapy, imply that home is always superior, or use the absence of visible home patients as proof it fails.Play from here
• Do not place the whole home-treatment burden on a care partner when the patient can safely learn and perform tasks.Play from here

Clinical pearl / safety

• Encourage patients to learn more, involve the training nurse/doctor and social worker, and use teachable moments. Confirm that both patient and training nurse believe the plan is safe before going home.Play from here

Exam cue

• Explain all feasible options neutrally; refer individualized selection, eligibility, and prescription questions to the licensed team.Play from here

Study guide

• PD is a daily self-care treatment that can occur at home or work. A catheter is placed in the abdomen; the patient’s peritoneum, rich in capillaries, serves as the exchange membrane.Play from here
• Sterile dialysate enters the abdomen, dwells for hours while wastes and water move into it, then drains and is replaced. One drain-and-fill cycle is an exchange.Play from here
• PD advantages include flexibility, portability, fewer diet/fluid limits than standard in-center HD, no treatment needles, and a sense of independence.Play from here
• The major infection concern is peritonitis, an infection of the peritoneum. Hand hygiene, masking, airflow control, and aseptic technique are essential. Catheter infection can also occur.Play from here
• Patients need room to store enough bags—potentially a several-week supply—and must maintain regular adequacy and residual-kidney-function testing.Play from here
• Residual kidney function can continue removing water and wastes. As it declines, the peritoneum may become less effective and a patient may need to change to HD.Play from here

CAPD — continuous ambulatory PD

• CAPD uses hand exchanges, commonly about four each day, often around meals and bedtime. A patient may shift timing slightly to fit life but must complete all prescribed exchanges.Play from here
• Each exchange takes roughly 20–30 minutes. A patient washes hands, controls room airflow, wears a mask until connections are complete, and follows the trained sterile process.Play from here
• The abdomen remains filled with dialysate between exchanges, so treatment is continuous. The patient must leave the room during the exchange to protect the sterile field.Play from here

CCPD/APD — cycler PD

• A machine performs exchanges overnight while the patient sleeps, commonly for about 8–10 hours. Long tubing may permit movement after connection, including a bathroom trip.Play from here
• Some patients add one or two daytime hand exchanges. The main advantage is keeping daytime hours available for work, school, or other activities.Play from here

Why answers are correct

• PD uses the patient’s own peritoneal capillaries rather than an external dialyzer. Its daily/continuous pattern can reduce large intermittent shifts, but it requires meticulous infection prevention and reliable self-care.Play from here
• CAPD and APD differ primarily in who/what performs the exchanges and when, not in the basic peritoneal membrane principle.Play from here

Limitations / traps

• “No needles” does not mean “no infection risk.” Breaks in aseptic technique can cause peritonitis.Play from here
• PD is not permanently effective for every patient; loss of residual function or declining membrane performance may require HD.Play from here
• A catheter, supplies, storage space, training, and a workable home environment are necessary; assess barriers rather than assuming refusal.Play from here

Clinical pearl / safety

• New abdominal symptoms, fever, cloudy or unusual effluent, drainage problems, or catheter-site changes during PD require prompt nurse notification and follow-up under the PD protocol.Play from here

Exam cue

• PD: catheter → sterile dialysate in → dwell → waste/water diffuse into fluid → drain → fresh exchange.Play from here

Compare / contrast: CAPD and CCPD/APD

Study guide

• HD pumps blood out of the body through a dialyzer containing thousands of hollow fibers, then returns it. Blood flows inside the fibers; dialysate bathes the outside, and water/some wastes cross the fiber membrane.Play from here
• Only about half a cup of blood is outside the body at one time in the chapter’s example.Play from here
• Access types:
  1. Arteriovenous fistula (AVF): the patient’s artery and vein are surgically joined; preferred when vessels support it.
  2. Arteriovenous graft (AVG): a synthetic tube links artery and vein; often next choice when a fistula is not possible.
  3. Central venous catheter (CVC): a tube enters a large vein in the neck, chest, or groin with the tip near the vena cava; useful for urgent dialysis or poor vessels but more prone to infection and poor flow.
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• Fistulas/grafts usually use two needles and bloodlines. A catheter can connect bloodlines without needles; a single-needle setup may be used in selected small or maturing accesses and some home-HD plans.Play from here

Why answers are correct

• Blood must travel through a safe, high-flow route to the dialyzer and back. The access determines infection, bleeding, flow, and longevity risks.Play from here
• A CVC is convenient for immediate access but is not automatically the best long-term access.Play from here

Limitations / traps

• Never cannulate, clamp, dress, or manipulate access outside training and facility policy. Protect the access from pressure, infection, and accidental disconnection.Play from here
• “The machine is running” does not prove adequate treatment; poor flow, alarms, access problems, and shortened time can reduce delivery.Play from here

Clinical pearl / safety

• Report bleeding, swelling, redness, drainage, pain, fever, absent/changed thrill or bruit, access alarms, or a sudden flow problem immediately.Play from here

Exam cue

• Fistula first when feasible; graft next; catheter often fastest but carries greater infection/flow risk.Play from here

Study guide

• Standard ICHD commonly occurs in a clinic three times weekly, often Monday/Wednesday/Friday or Tuesday/Thursday/Saturday, for about 3–4 hours per treatment (roughly 9–12 hours weekly).Play from here
• The chapter contrasts this with healthy kidneys working 168 hours per week. Longer treatments generally remove fluid more gently and provide more clearance.Play from here
• A cited multinational study found at least four-hour treatments had lower mortality than shorter treatments, and each additional 30 minutes beyond four hours was associated with further risk reduction. These are associations, not permission to alter a prescription.Play from here
• Benefits: nurses/technicians are present, supplies are provided, no home partner is required, and the clinic can provide social contact.Play from here
• Limitations: fixed shifts, travel three times weekly, possible work/school and childcare conflict, greater diet/fluid and medication burden, and a two-day weekend gap.Play from here
• The “killer gap” is the two-day no-treatment interval for a three-times-weekly schedule. Patients may arrive after the weekend with the greatest weight gain and electrolyte imbalance; the chapter reports higher risk on Monday/Tuesday than other days.Play from here
• When medically prescribed, all three weekly treatments may be used to catch up while keeping ultrafiltration from exceeding a safe rate. Every-other-day treatment avoids the two-day gap but is uncommon in clinics.Play from here
• Incremental HD: patients with substantial urine output may begin with fewer/shorter treatments or slower flows, then increase as kidney function declines.Play from here

Why answers are correct

• Frequency and duration shape fluid removal, toxin control, symptoms, and cardiovascular stress. A patient’s “usual” cramps or hypotension still deserves assessment.Play from here

Limitations / traps

• Do not shorten treatment because the patient feels better or wants to leave without the nurse’s assessment and prescribed plan.Play from here
• Do not interpret the killer-gap discussion as a reason to change schedule independently.Play from here

Clinical pearl / safety

• A patient who arrives after a long gap with high weight gain, shortness of breath, weakness, chest symptoms, or confusion needs prompt assessment before and during treatment.Play from here

Exam cue

• Standard ICHD = usually 3 days/week; the long gap, not merely the single session, is a key risk.Play from here

Study guide

• Nocturnal ICHD occurs at night, commonly three nights weekly, with about 7–8 hours in the clinic while the patient sleeps.Play from here
• Compared with standard ICHD, it provides more treatment time, slower/gentler fluid removal, fewer cramps, fewer diet/fluid limits, and potentially fewer medicines. It can leave days open for work.Play from here
• The chapter cites improved heart findings, lower PTH/phosphorus, and better survival associations than standard ICHD. Availability is limited; patients may need to travel farther or prefer home therapy.Play from here

Why answers are correct

• More time allows the same general work to occur with less rapid fluid and solute change. Longer treatment is not simply “more of the same” when it changes hemodynamic stress.Play from here

Limitations / traps

• Do not assume nighttime treatment is available at every clinic or suitable for every patient. It still requires reliable attendance and access safety.Play from here

Clinical pearl / safety

• Explain that “night treatment” is a schedule and dose choice, not a reason to ignore alarms, access checks, or patient symptoms.Play from here

Study guide

• Standard home HD may follow three-times-weekly or every-other-day schedules. Patient and/or care partner commonly train with a nurse for about 4–6 weeks.Play from here
• Training includes needle placement, supply ordering, machine operation, infection prevention, prescribed medicines, vital signs and samples, problem reporting, emergency response, and waste disposal.Play from here
• Home HD can offer flexible timing, longer or more frequent treatment, fewer symptoms and diet/fluid limits, and improved work/school compatibility.Play from here
• Requirements may include a trained partner, storage space, plumbing or electrical changes, and a safe home setup. Not every patient can or wants to meet them.Play from here

Why answers are correct

• The patient/care partner becomes responsible for day-to-day operations, but the home program remains a clinical relationship with training and support. Independence is not abandonment.Play from here

Limitations / traps

• Never assume a care partner must carry the whole treatment. The patient should learn as much as safely possible.Play from here
• Home treatment still has access, bleeding, infection, machine, and emergency risks; training and 24/7 support plans matter.Play from here

Clinical pearl / safety

• Confirm emergency procedures, supply availability, machine alarms, and who to call before encouraging home treatment. Escalate any home-treatment concern to the home program.Play from here

Study guide

• DHHD commonly uses shorter treatments, about 2.5–4 hours, on 5–6 days each week, often at home because daily clinic travel is impractical.Play from here
• Shorter, frequent treatments can fit morning or evening routines, work, and family life. The chapter reports improvements such as better sleep and fewer restless-leg episodes in a cited experience.Play from here
• A smaller, easier-to-set-up machine can make short home treatments more practical. In 2017, the FDA approved solo daytime use of a NxStage machine; eligibility and current device rules still require the program’s assessment.Play from here

Why answers are correct

• More frequent treatment reduces the long interdialytic gap and may smooth fluid/solute shifts, but it increases the number of treatment days and self-care tasks.Play from here

Limitations / traps

• “Daily” does not mean treatment is automatically safer or suitable without training, access assessment, and a prescribed schedule.Play from here

Study guide

• NHHD is performed at home during sleep, commonly 3–7 nights weekly for 7–8 hours. A patient and care partner learn the setup; some programs monitor the treatment online.Play from here
• Needles and blood tubing are secured. Slow flow and blood-leak alarms provide time to respond, but the patient still needs training and an emergency plan.Play from here
• Studies cited in the chapter associate NHHD with higher albumin, less need for phosphate binders, better nutrition, fewer diet/fluid limits, better quality of life, and improved heart findings compared with standard ICHD.Play from here
• People far from a clinic or needing daytime hours for work or childcare may find NHHD attractive. Availability and suitability vary.Play from here

Why answers are correct

• Long, frequent overnight treatment approximates more continuous clearance and allows gentler fluid removal; benefits are population findings, not a guarantee.Play from here

Limitations / traps

• Sleeping through treatment does not eliminate access-disconnection or machine risks. Never bypass alarms or change settings without the home program.Play from here

Clinical pearl / safety

• Ensure the patient and partner can recognize blood-leak, access, and machine alarms and know when to stop/seek help according to the home program’s emergency plan.Play from here

Compare / contrast: HD options

Study guide

• Without dialysis or transplant, kidney failure eventually causes death. Active medical management (also called conservative or comfort-focused management in this context) treats symptoms and supports quality of life without dialysis.Play from here
• It may fit some frail older adults, people with serious comorbid illness, or people with substantial pain for whom dialysis may not extend life or may impose more burden than benefit.Play from here
• Some patients may try dialysis and stop if symptoms and quality of life remain poor. The choice should be deliberate and supported, not the result of untreated depression, misinformation, or abandonment.Play from here
• Most major religions distinguish allowing natural death from suicide; beliefs and patient values should be respected.Play from here
• When treatment is stopped, the care team manages symptoms. Counseling, medication, a modality change, palliative care, and hospice may help patients and families.Play from here
• Advance directives let patients state desired care during a future health crisis and identify whether the clinic will honor those wishes. Patients may change clinics if needed to have wishes respected.Play from here

Why answers are correct

• “No dialysis” is not “no care.” It is an active plan centered on symptoms, goals, communication, and support.Play from here
• The decision belongs to the informed patient with the clinical team; technicians should not pressure, debate, or frame it as giving up.Play from here

Limitations / traps

• Never advise a patient to stop dialysis, predict an individual survival time, or treat a treatment decision as proof of depression or lack of hope.Play from here
• A comfort-focused plan still requires escalation of distressing symptoms and respect for advance directives.Play from here

Clinical pearl / safety

• If a patient expresses a wish to stop treatment, hopelessness, uncontrolled symptoms, or concern about goals of care, listen without judgment and promptly notify the nurse/social worker/appropriate team member.Play from here

Exam cue

• Conservative care is a planned, active treatment pathway focused on comfort and goals—not abandonment and not a technician decision.Play from here

Study guide

• Kidney failure treatment affects every part of daily life. Patients who learn the options can choose, reconsider, or combine clinical advice with personal priorities.Play from here
• A technician’s role is to support informed choice, notice barriers and symptoms, communicate accurately, protect safety, and connect the patient with the licensed team.Play from here

Why answers are correct

• The best answer in a vignette often identifies both the physiologic issue and the patient-centered response: explain within scope, avoid bias, involve the nurse/doctor/social worker, and follow the prescribed plan.Play from here

Uncommon words from this chapter. Plain definitions + a short dialysis-related example.Play from here

autonomy

The patient's right to make informed choices about their own care.

Example. Staff should explain options without steering, so autonomy stays with the patient.

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immunosuppression

Medicine that lowers immune attack so a transplanted kidney is not rejected.

Example. Recipients need lifelong immunosuppression while the graft works.

Play from here

graft

The donated kidney (or the synthetic tube used as access in later chapters).

Example. A transplant graft may last years, but it is not a guaranteed cure.

Play from here

rejection

The immune system attacking a transplanted organ as foreign.

Example. New illness after transplant can be rejection and belongs to the transplant team.

Play from here

comorbidity

Another illness that exists along with kidney failure.

Example. Comorbidity can affect whether a person qualifies for transplant or home therapy.

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preemptive

Done before dialysis is needed.

Example. A preemptive transplant may be considered when GFR is about 20 or lower.

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desensitization

Special immune treatment that can allow some mismatched transplants.

Example. ABO-incompatible transplant may be possible after desensitization.

Play from here

residual

What kidney work is still left.

Example. As residual kidney function falls, PD may become less effective.

Play from here

aseptic

Done in a way that keeps germs out of a sterile connection or space.

Example. Breaks in aseptic technique can cause peritonitis.

Play from here

peritonitis

Infection of the peritoneal lining of the belly.

Example. Cloudy effluent or new abdominal pain on PD can mean peritonitis.

Play from here

dwell

The time dialysate stays in the belly so wastes and water can move into it.

Example. A PD exchange is drain, then fill, then a prescribed dwell.

Play from here

nocturnal

Happening at night, often while the person sleeps.

Example. Nocturnal HD gives more treatment time with slower fluid removal.

Play from here

incremental

Started at a smaller dose and increased as needed.

Example. Incremental HD may begin with fewer treatments while urine output is still high.

Play from here

interdialytic

The time between dialysis treatments.

Example. The two-day interdialytic gap can bring the greatest weight gain and electrolyte risk.

Play from here

hemodynamic

Related to blood flow, blood pressure, and how the heart handles volume.

Example. Longer HD can reduce hemodynamic stress from rapid fluid shifts.

Play from here

palliative

Care focused on comfort and quality of life rather than curing the disease.

Example. Palliative support can continue when a person chooses medical management without dialysis.

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advance directive

Written wishes about future care if the person cannot speak for themselves.

Example. An advance directive can say whether the clinic should start or continue dialysis in a crisis.

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fistula

A surgical join of the patient's own artery and vein used for HD access.

Example. A fistula is preferred when vessels can support it because it lasts longer and infects less often than a catheter.

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conservative care

Active medical management of symptoms without dialysis or transplant.

Example. Conservative care is planned comfort-focused treatment, not abandonment.

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semipermeable

A barrier that lets some particles and water through but not others.

Example. Dialysis works across a semipermeable membrane that separates blood from dialysate.

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Must-know

1. Name the major treatment pathways in the chapter: transplant, PD, HD variants, and active medical management without dialysis.Play from here
2. Explain why transplant is not a cure and why immunosuppression continues after surgery.Play from here
3. List the three donor sources and explain living donation, paired exchange, and chain donation.Play from here
4. Distinguish KP/SPK transplant from kidney-only transplant and define preemptive transplant.Play from here
5. State what KDPI and EPTS broadly estimate; recognize ABO-incompatible transplant as requiring desensitization.Play from here
6. Compare continuous kidney function with dialysis’s partial, scheduled replacement of water and wastes.Play from here
7. List the seven dialysis approaches in the module.Play from here
8. Describe PD: catheter, peritoneal membrane, dialysate, dwell, drain, and exchange.Play from here
9. Compare CAPD (hand exchanges) with CCPD/APD (cycler, usually overnight).Play from here
10. Identify peritonitis and catheter infection as major PD safety concerns; explain why aseptic technique matters.Play from here
11. Explain how residual kidney function affects PD effectiveness and modality changes.Play from here
12. Describe HD blood flow through access → dialyzer fibers → return to patient, with dialysate outside the fibers.Play from here
13. Compare AV fistula, AV graft, and CVC; know why fistula is preferred when feasible and CVC has greater infection/flow risk.Play from here
14. State the usual standard ICHD pattern and explain the two-day “killer gap.”Play from here
15. Explain incremental HD and why treatment time/frequency should never be changed independently.Play from here
16. Compare standard and nocturnal in-center HD: schedule, treatment time, fluid removal, and availability.Play from here
17. List home-HD training topics and home requirements, including partner/support, space, supplies, alarms, infection prevention, and emergency response.Play from here
18. Compare standard home HD, daily home HD, and nocturnal home HD by timing, frequency, and patient-life fit.Play from here
19. Why can longer or more frequent HD reduce rapid fluid/solute shifts? What risks remain?Play from here
20. Define active medical management without dialysis and explain why it remains active care.Play from here
21. Explain the technician response to a patient asking about modality change: provide unbiased scope-appropriate information and refer to the nurse/home-training team or doctor.Play from here
22. In any treatment-option vignette: identify the patient goal, the physiologic/safety issue, the feasible options, the scope boundary, and the correct escalation/documentation step.Play from here