Fluid Management in Haemodialysis: Studies on current practices and new methods

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Stenberg, Jenny,1976-Uppsala universitet,Njurmedicin (författare)

Fluid Management in Haemodialysis : Studies on current practices and new methods

BokEngelska2020

Förlag, utgivningsår, omfång ...

Uppsala :Acta Universitatis Upsaliensis,2020
72 s.
electronicrdacarrier

Nummerbeteckningar

LIBRIS-ID:oai:DiVA.org:uu-407956
ISBN:9789151309354
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-407956URI

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Språk:engelska
Sammanfattning på:engelska

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Ämneskategori:vet swepub-contenttype
Ämneskategori:dok swepub-publicationtype

Serie

Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine,1651-6206 ;1664

Anmärkningar

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.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Urologi och njurmedicin hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Urology and Nephrology hsv//eng
Haemodialysis
Fluid management
Fluid overload
Bioimpedance spectroscopy
Dry weight
Brain natriuretic peptide
Decision aid
Medicinsk vetenskap
Medical Science

Biuppslag (personer, institutioner, konferenser, titlar ...)

Furuland, Hans,PhD, MDUppsala universitet,Njurmedicin(Swepub:uu)hansfl (preses)
Lindberg, Magnus,PhD, Associate professor, RNUppsala universitet,Centrum för klinisk forskning, Gävleborg,Vårdvetenskap(Swepub:uu)malin535 (preses)
Tiensuu Janson, Eva,PhD, Professor, MDUppsala universitet,Onkologisk endokrinologi(Swepub:uu)evatieja (preses)
Stegmayr, Bernd,ProfessorUmeå Universitet, Institutionen för folkhälsa och klinisk medicin (opponent)
Uppsala universitetNjurmedicin (creator_code:org_t)

Internetlänk

https://join.lul.seOnline Defence. Meeting ID: 103370
https://uu.diva-portal.org/smash/get/diva2:1421455/FULLTEXT01.pdffulltext
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-407956

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