A patient on hemodialysis presents for dental treatment. Which finding should you MOST expect?

Correct answer: C. Hypertension

• A. Adrenal crisis relates to long-term corticosteroid therapy or adrenal insufficiency, not to dialysis per se.
• B. Dialysis patients are ANEMIC, not polycythemic, because the failing kidney produces insufficient erythropoietin.
• C. CORRECT. HYPERTENSION is present in the large majority of dialysis patients, driven by fluid overload between sessions, activation of the renin-angiotensin system, and secondary hyperparathyroidism. Other expected findings: anemia (reduced erythropoietin), bleeding tendency from uremic platelet dysfunction and heparin used during dialysis, renal osteodystrophy, and altered drug clearance. Treat on the DAY AFTER dialysis, when heparin has cleared and fluid status is optimal, and never use the arm containing the AV fistula for blood pressure or IV access.
• D. Hyperglycemia occurs only if the patient is also diabetic — diabetes is a common cause of ESRD, but it is not a consequence of dialysis.

Note: Practical rules: treat the day AFTER dialysis; avoid nephrotoxic drugs (NSAIDs, aminoglycosides, tetracycline); adjust doses of renally cleared drugs; never touch the fistula arm.