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Abstract: FR-OR30

Implementation of a Decision Aid for Recognition and Correction of Volume Alterations (Recova®) in Hemodialysis

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Stenberg, Jenny, Uppsala University Department of Medical Sciences, Uppsala universitet Institutionen for medicinska vetenskaper, Uppsala, Sweden
  • Lindberg, Magnus, Hogskolan i Gavle, Gavle, Sweden
  • Furuland, Hans, Uppsala University Department of Medical Sciences, Uppsala universitet Institutionen for medicinska vetenskaper, Uppsala, Sweden
Background

Chronic fluid overload is an independent predictor of mortality in hemodialysis. 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 NT-proBNP increased. In the remaining 19 participants, with low volume status scores, no significant changes were observed.

Conclusion

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 contributed to symptom reduction.

Overhydration at base-line and at end-of-study

Funding

  • Clinical Revenue Support