Implementation of a Decision Aid for Recognition and Correction ofVolume Alterations (Recova®) in Hemodialysis

• Background: Chronic fluid overload is an independent predictor of mortality inhemodialysis. Clinical assessment of fluid status is subjective and unprecise, and 30% of the patients remain fluid overloaded at dry weight. This study evaluates the effects of implementing a recently developed decision aid, Recova®, which combines a systematized fluid status procedure with bioimpedance spectroscopy, for individualized dry weight determination in hemodialysis.Methods: The study was a prospective implementation intervention carried out at two hemodialysis units. The impact of the intervention was measured as the proportion of participants at an adequate dry weight at the end of the study, assessed as change in symptoms, hydration status, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Hemodialysis nurses were instructed to use Recova® every two weeks, assessing the study participants’ fluid status and adjusting their dry weights as appropriate. The process of the intervention was measured as frequencies of fluid status assessments, bioimpedance measurements, and dry weight adjustments.Results: Forty-nine patients were enrolled. In participants with fluid overload (n = 10), both bioimpedance-measured overhydration and fluid overload symptom score decreased. In fluid-depleted participants (n = 20), dry weight adjustment frequency and dry weight increased. The post-dialytic negative overhydration was reduced, but NTproBNP increased. In the remaining 19 participants, with low volume status scores, no significant changes were observed.Conclusions: Recova® defines how and when dry weight should be evaluated in hemodialysis patients. Its purpose is to provide the multidisciplinary team with a common language, and thereby facilitate early recognition and appropriate response to fluid alterations. Implementation of Recova® in hemodialysis care increased the monthly frequencies of bioimpedance measurements and dry weight adjustments, and contributedto symptom reduction.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Urology and Nephrology (hsv//eng)

Keyword

Medicinsk vetenskap

Medical Science

Publication and Content Type

ref (subject category)

kon (subject category)