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Abstract: FR-PO747

Reduction in Mean Patient Body Weights and Blood Pressures Were Observed During a Fluid Management Quality Improvement (QI) Project Utilizing Relative Blood Volume Monitoring (RBV-M)

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Balter, Paul, Nephrology Associates of Northern Illinois and Indiana (NANI), Oak Brook, Illinois, United States
  • Li, Yisha, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Mullon, Claudy, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Kossmann, Robert J., Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Ficociello, Linda, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
Background

A one-year fluid management QI project utilizing RBV-M was conducted at 20 Renal Research Institute clinics. A retrospective database analysis of the QI project was conducted to assess changes in body weight and blood pressure in hemodialysis (HD) patients.

Methods

Patients included in this analysis received HD in the month before QI initiation (Pre-QI ) and QI end. RBV-M was used to monitor relative blood volume during hemodialysis with Crit-Line® Monitors (CLM-III, CLM-IV, or CLiC). All available PreHD- and PostHD- body weights (wt) and PreHD- and PostHD- systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were averaged monthly for each patient. A subgroup analysis of patients with Pre-QI hypertension was conducted for patients with PreHD-SBP ≥ 140 mmHg and/or PreHD-DBP ≥ 90 mmHg during Pre-QI. Paired t-tests were utilized to test for difference between Pre-QI and QI month 12 (M12).

Results

In total, 651 patients were included in the analysis and 473 had Pre-QI hypertension. Mean PreHD-wt decreased from 84.06 to 83.27 kg (-0.79 kg, p<0.0001) and PostHD-wt from 81.71 to 80.96 kg (-0.75 kg, p<0.0001) from Pre-QI to M12. Mean PreHD-SBP decreased from 152.04 to 149.92 mmHg (-2.12 mmHg, p=0.005) and mean PostHD-SBP decreased from 139.32 to 137.09 mmHg (-2.23 mmHg, p=0.003) from Pre-QI to M12. Mean PreHD-DBP decreased from 80.07 to 78.70 mmHg (-1.37 mmHg, p=0.002) and PostHD-DBP decreased from 73.69 to 72.41 mmHg (-1.28 mmHg, p=0.001) from Pre-QI to M12. On average, in the subgroup of patients with hypertension during Pre-QI, PreHD-SBP decreased from 161.54 to 156.55 mmHg (-4.99 mmHg, p<0.0001) and PostHD-SBP decreased from 145.56 to 141.56 mmHg (-4.00 mmHg, p<0.0001).

Conclusion

A QI project on fluid management utilizing RBV-M was associated with reductions in patient body weights and blood pressures. Most patients had Pre-QI hypertension (73%). These patients had an average decrease in PreHD-SBP of 4.99 mmHg and may be a population that could particularly benefit from a QI initiative on fluid management.

Funding

  • Commercial Support