Abstract: PUB100
Impact of an Educational Effort for Fluid Management in an Underserved Urban Population Receiving Maintenance Hemodialysis
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Silberzweig, Jeffrey I., Weill Cornell Medicine, New York, New York, United States
- Saal, Stuart D, The Rogosin Institute, New York, New York, United States
- Perry, Ivonne A, The Rogosin Institute, New York, New York, United States
Background
Excess interdialytic fluid intake is common and can have devastating impacts on patients with ESKD receiving hemodialysis. We assessed the impact of an educational program provided by a Nurse Educator combined with peer mentoring by "Wellness Ambassadors” on intake.
Methods
In our urban underserved population, patients were offered a “fluid focused” lobby day where information about ‘dry weight’, ‘tips’ for measuring fluid intake, and the risks of fluid overload including hospitalization was provided.
Eleven patients defined as having excess intake based on high ultrafiltration rates (UFR) and frequent excursions above target weight after treatment were selected to receive individualized education by the nurse educator and peer mentors then monitored over a three-month period.
Results
During a 3-month baseline period, the study patients left an average of 64 treatments per month above target weight. Project participants contributed up to 10% fewer outlier treatments after the educational effort while those who did not receive the intervention had increased outlier treatments. After a three-month observational period, the improvements waned.
Conclusion
Factors associated with higher rates of improvement included openness to education and shorter dialysis vintage. Increased ability to self-advocate (patient activation) was associated with controlled fluid intake. Exposure to peer mentors increased patient activation.
Lower rates of improvement were associated with more co-morbid medical conditions, negative feelings about the impact of dialysis on quality of life, and ingrained misconceptions about kidney disease and dialysis.
Educational efforts provided by medical staff led by a dedicated nurse educator provide short-term benefits for restricting fluid intake in our underserved urban population. Peer mentorship holds promise for improving adherence to fluid restriction and clinical outcomes.
Limitations: We were not able to assess the impact of peer mentoring directly.
Outlier Treatment Frequency
| Month | Control Population | Study Population |
| 1 | 68 | 62 |
| 2 | 82 | 58 |
| 3 | 59 | 61 |
| 3-month average | 69.67 | 60.33 |
Funding
- Private Foundation Support