Systematic fluid assessment in haemodialysis care: : Development and validation of adecision aid

• BackgroundOverhydration is a mortality risk factor in haemodialysis patients, and about a third of patients have poorly controlled fluid balance. Bioimpedance is a technique that can detect excess body water. However it is important to recognize that bioimpedance adds information to what is already a complex decision-making process, rather than providing a simple target applicable to all patients. Clinical guidelines incorporating the information from bioimpedance in determination of dry weight are lacking.ObjectivesTo develop and validate a decision aid, which standardizes the process of recording, scoring and responding to changes in routinely measured physiological parameters, and provides a basis for a unified and systematic approach to the assessment of volume status in haemodialysis care.MethodsWe are developing a scoring system, which we have named Subjective Volume Status Score (SVSS). Experts in theuse of bioimpedance have been included to address face-validity. In order to test the reliability of SVSS, nurses from a number of British and Swedish haemodialysis units will be recruited to use SVSS in individual assessments of four typical patient cases. Their assessments will be analyzed with inter-rater agreement analysis.ResultsSVSS consists of:A scoring system, built upon six physiological parameters, for detection and assessment of clinical symptoms of impaired hydration statusThresholds and triggers, a simple track-and-trigger system guiding the caregiver in deciding when and how to respondA decision aid, which helps to incorporate the information from bioimpedance when setting the dry weight, and aims to facilitate communication in the team, by providing a common language.Conclusion/Application to practiceOur guiding principle is that if SVSS is going to work in diverse haemodialysis care settings, then it must be simple to implement and must use physiological parameters that are already being routinely measured in the haemodialysis care.

Ämnesord

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

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

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Medicinsk vetenskap

Medical Science

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