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- Stenberg, Jenny, 1976-
(författare)
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Fluid Management in Haemodialysis : Studies on current practices and new methods
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic fluid overload has been identified as an independent predictor of mortality in haemodialysis patients, and 30% remain fluid overloaded at dry weight. The use of bioimpedance spectroscopy (BIS) in fluid management may improve blood pressure control and cardiovascular status. However, the importance of regular and careful clinical assessment of fluid balance is repeatedly emphasised.This thesis is based on five papers and the overall aim was to investigate current practices and new methods for fluid management in haemodialysis, and to develop a management tool for dry weight determination, based on multiple complementary methods. The purpose was to contribute to reduced prevalence of fluid overload and intradialytic symptoms in haemodialysis patients, by providing the healthcare team and the patient with a tool, that facilitates communication and enables informed decision-making in dry weight determination.In the initial, cross-sectional study, clinical praxis for dry weight assessment in Sweden and Denmark was investigated. A wide variation in routines was found. Despite high access, BIS was sparsely used. Instead, nurses’ authorisation to adjust haemodialysis patients’ dry weight was associated with improved fluid status. The second study had a qualitative approach. Focus group interviews, with healthcare professionals, were carried out to achieve a deeper understanding of the factors preventing or facilitating the use of BIS. In the third study, the usefulness of a biomarker, brain natriuretic peptide (BNP), for assessing fluid status in haemodialysis patients, was investigated. An association between BNP and fluid overload was established. The between-individual variation in BNP levels was greater than the within-individual variation over time. Therefore, if BNP is to be used as a marker for fluid overload, repeated measurements are required. In the fourth study, we developed and validated a multifactorial decision aid, Recova®, that incorporates BIS in dry weight determination. Recova® is based on physiological parameters routinely measured in haemodialysis and provides guidance on when and how to respond to recognised fluid alterations. In the fifth study, the decision aid’s effect on volume status was tested in a cohort of haemodialysis patients. Implementation of Recova® had effect on fluid status symptoms, BIS-measured hydration status and NT-proBNP levels.
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| 2. |
- Stenberg, Jenny, 1976-, et al.
(författare)
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Implementation of a decision aid for recognition and correction of volume alterations (Recova®) in haemodialysis patients
- 2020
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Ingår i: Upsala Journal of Medical Sciences. - : Taylor & Francis Group. - 0300-9734 .- 2000-1967. ; 125:4, s. 281-292
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fluid overload is associated with mortality in haemodialysis patients, and 30% of patients remain fluid-overloaded after dialysis. The aim of this study was to evaluate if implementation of Recova®, a decision aid combining clinical assessment with bioimpedance spectroscopy, facilitates individualization of target weight determination and thereby contributes to improved fluid status in maintenance haemodialysis patients.METHODS: The impact of the implementation was measured as the proportion of participants at an adequate target weight at the end of the study, assessed as change in symptoms, hydration status, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Nurses were instructed to use Recova every 2 weeks, and the process of the intervention was measured as frequencies of fluid status assessments, bioimpedance measurements, and target weight adjustments.RESULTS: Forty-nine patients at two haemodialysis units were enrolled. In participants with fluid overload (n = 10), both overhydration and fluid overload symptom score decreased. In fluid-depleted participants (n = 20), target weight adjustment frequency and the estimated target weight increased. The post-dialytic negative overhydration was reduced, but NT-proBNP increased.CONCLUSIONS: Implementation of Recova in haemodialysis care increased the monthly frequencies of bioimpedance measurements and target weight adjustments, and it contributed to symptom reduction.TRIAL REGISTRATION: The Uppsala County Council Registry of Clinical Trials: FoU 2019-0001-15.
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| 3. |
- Stenberg, Jenny, 1976-, et al.
(författare)
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Implementation of a Decision Aid for Recognition and Correction ofVolume Alterations (Recova®) in Hemodialysis
- 2020
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Konferensbidrag (refereegranskat)abstract
- 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.
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