Kidney Week

Abstract: FR-PO0482

Follow-Up of Fluid Management Support Algorithm Company-Wide Rollout

Session Information

• Dialysis: Hemodiafiltration, Ultrafiltration, Profiling, and Interdialytic Symptoms
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Goldberg, Marcy Eber, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States

Marcy Eber Goldberg

• Ficociello, Linda, Renal Research Institute, New York, New York, United States

Linda Ficociello, PhD

• Stennett, Amanda K, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States

Amanda K Stennett, PhD

• Rivenbark, Amanda Short, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States

Amanda Short Rivenbark, RN

• Chatoth, Dinesh K., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States

Dinesh K. Chatoth, MD, FASN

Background

A large dialysis organization piloted a fluid management support algorithm. After 3 years, algorithm use was expanded to all clinics. The algorithm was digitally integrated at point of care to give real-time patient-specific messages. The messages provide a recommended intervention to the caregiver that, if accepted, may result in a real-time treatment or prescription change. An analysis of the pilot clinics showed that clinics with a higher rate of recommendation acceptance experienced more positive clinical outcomes. This follow up analysis assesses the pilot findings against results in clinics in the company-wide rollout.

Methods

All dialysis clinics not part of the pilot having 6 months of algorithm use as of March 2025 were included. Analysis focused on the fluid-related hospitalization rate for the 6 months before and after start of algorithm use. For each clinic we determined a rate of acceptance of the recommended action. Clinics were then stratified by whether they had a higher (top 25^th percentile) or lower rate of acceptance.

Results

In the company-wide rollout, over 2.9 million recommendations, from 796 clinics were included in analysis. 1.4 million recommendations, from 373 clinics were included in the pilot. Key demographic metrics were similar between the time periods. Clinics were stratified by whether they had a higher (top 25%) or lower rate of accepted action occurrence. The top 25% of clinics during the pilot accepted more recommendations (>47.2%) than during the company-wide rollout (>39.6%). Only 8% of clinics in the company-wide rollout accepted 47.2% or more of recommendations. In the pilot, fluid related hospital admission rate was reduced by 14.7% in clinics with top 25% acceptance compared to lower acceptance, whereas in the company-wide rollout fluid-related hospital admission rate was reduced by 7.7%.

Conclusion

In the first 6 months of use of a Fluid Management Clinical Support Algorithm, fluid-related hospitalization rate improved overall, and more significantly for clinics with a higher rate of acceptance. Fluid-related hospital admission rate was reduced by 14.7% and 7.7% in clinics with higher acceptance rates during the pilot and company-wide rollout, respectively.

Funding

• Commercial Support – Fresenius Medical Care Global Medical Office

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025ndcvp9d9