Clinical praxis for assessment of dry weight in Sweden and Denmark: : a mixed-methods study

• BackgroundOverhydration is an independent predictor of mortality in hemodialysis (HD) patients, and more than 30% of all HD patients may be overhydrated. Insufficient volume control has actuated development of objective tools, e.g. bioimpedance spectroscopy (BIS), for assessment of hydration status.ObjectivesThe aim was to investigate clinical praxis, local guidelines and routines for assessment of dry weight (DW) in Swedish and Danish HD units, and to compare differences in routines with levels of blood pressure (BP).MethodsIn this cross-sectional study a questionnaire was used to collect information about clinical praxis, routines and guidelines; qualitative and quantitative data were analyzed convergent with statistical analysis of retrospective treatment related data of 99 stratified patients, in a mixed methods design.ResultsWritten local guidelines concerning DW existed in 54% of the units, and 52% had a BIS-device, but few used it on regular basis. HD nurses (HDN) were prime initiators of utilization of BIS. The frequency of DW adjustment was 1.6 times higher and systolic BP preHD 8 mmHg lower if HDN were authorized to adjust DW.Conclusion/Application to practiceThere is wide variation in routines for DW assessment in Swedish and Danish HD units, and implementation of BIS may have been delayed by uncertainty of how to manage the device and interpret measurements. There may be a correlation between morefrequent DW adjustments, authorization of HDN to adjust DW and lower BP. Adequate hydration status is fundamental in HD, thus better methods and guidelines for assessment of DW and utilization of BIS need to be developed.

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)