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After completing this case study, the reader should be able to:

  • Identify medication-related problems in a patient with end-stage kidney disease maintained on chronic hemodialysis.

  • State the desired therapeutic outcomes of each problem.

  • List therapeutic alternatives for managing each problem.

  • Develop a plan for managing each problem that includes plans for monitoring patient response to interventions.

  • Outline a plan for helping the patient understand and effectively implement medication-related interventions.


Chief Complaint

“I feel tired, nauseated, and constipated.”


Jane Lopez is a 42-year-old woman who presents to the outpatient dialysis center for her routine HD treatment. She has ESRD secondary to hypertension and has been on HD for 4 years. She has a failed AV fistula and graft and is currently dialyzed via central venous catheter. She has an upcoming appointment with the vascular surgeon to reevaluate her HD access. She also frequently leaves HD 30–60 minutes early against medical advice.


ESRD secondary to HTN




Secondary hyperparathyroidism

H/O gestational diabetes 12 years ago



Cesarean section 12 years ago

Tubal ligation 10 years ago

AV fistula creation 5 years ago (failed)

AV graft creation 3 years ago (failed)


Father died of MI at age 60. Mother deceased due to breast cancer. No siblings. Has a 12-year-old son in good health.


Married, lives with husband and a 12-year-old son. Occasional social alcohol use. Smokes 1/2 ppd (decreased from one ppd × 10 years). Denies caffeine consumption.


Complains of feeling tired and weak over the past several weeks. Reports some swelling in feet and lower legs. Also reports constipation, nausea, and heartburn.


Furosemide 80 mg PO daily

Metoprolol tartrate 50 mg PO BID

Lisinopril 20 mg PO daily

Calcium acetate 667 mg three caps PO TID with meals

Nephro-Vite PO daily

Omeprazole 20 mg PO daily

Ferrous sulfate 325 mg PO TID

Docusate 100 mg PO daily PRN

Calcium carbonate PO PRN heartburn

Epoetin alfa 10,000 units IV three times weekly with dialysis (dose stable for 3 months)

Iron sucrose ...

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