Kidney Week

Abstract: SA-PO1075

Effect of Quality Improvement Interventions on Key Dialysis Fluid Metrics

Session Information

• Kidney Replacement Therapy and Care Delivery Innovations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Safi, Adnan, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States

Adnan Safi, MBBS

• Mengal, Fida, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States

Fida Mengal, MD, MBBS

• Syed, Jahanghir, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States

Jahanghir Syed, MD

• Kouyate, Gnama, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States

Gnama Kouyate, MD

• Akatibo, Emmanuel, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States

Emmanuel Akatibo, MBChB

• Nenwani, Hari Vishal, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States

Hari Vishal Nenwani, MBBS

• Delp, Crystal, SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States

Crystal Delp, MD, MBBS

• Gruessner, Angelika C., SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States

Angelika C. Gruessner, PhD

• Salifu, Moro O., SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States

Moro O. Salifu, MD, MBA, MPH

• Saggi, Subodh J., SUNY Downstate Health Sciences University College of Medicine, New York, New York, United States

Subodh J. Saggi, MD, MPH

Background

Fluid imbalance in maintenance hemodialysis is associated with cardiovascular complications and worse clinical outcomes. We evaluated whether a structured quality improvement (QI) intervention could improve key fluid management metrics in chronic hemodialysis patients.

Methods

We performed a prospective pre-post QI study in a single in-center hemodialysis unit over two 15-day periods. A total of 467 hemodialysis sessions were analyzed before and after implementation of a multidisciplinary intervention consisting of patient education, standardized nursing workflow for ultrafiltration (UF) verification, and weekly nephrologist review. Outcomes included the proportion of sessions with interdialytic weight gain (IDWG) greater than 2.5 kg, post-dialysis weight exceeding 1 kg above the prescribed dry weight, and a UF goal that differed from the actual UF removed by more than 1 kg.

Results

After the intervention, sessions with IDWG greater than 2.5 kg decreased from 29.5% to 9.8%. Sessions with post-dialysis weight more than 1 kg from dry weight decreased from 39.5% to 4.2%. A UF mismatch greater than 1 kg decreased from 40.3% to 4.3%. Absolute reductions were 19.7, 35.3, and 36.0 percentage points, respectively.

Conclusion

A low-cost, multidisciplinary QI intervention was associated with marked short-term improvement in fluid-related hemodialysis metrics. Team-based strategies focused on patient education, workflow standardization, and physician oversight may improve volume management and overall dialysis care.