uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Clinical praxis for assessment of dry weight in Sweden and Denmark: A mixed-methods study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Renal Medicine.ORCID iD: 0000-0003-2408-0087
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.ORCID iD: 0000-0003-1289-9896
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Renal Medicine.
2016 (English)In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 20, no 1, p. 111-119Article in journal (Refereed) Published
Abstract [en]

Overhydration is an independent predictor of mortality in hemodialysis (HD) patients. More than 30% of HD patients are overhydrated, motivating the development of new methods for assessing hydration status. This study surveyed clinical praxis and local guidelines for dry weight (DW) assessment in Swedish and Danish HD units, and examined if differences in routines and utilization of bioimpedance spectroscopy (BIS) and other assistive technology affected frequency of DW adjustments and blood pressure (BP) levels. Cross-sectional information on praxis, guidelines and routines, plus treatment-related data from 99 stratified patients were collected. Qualitative data were analyzed with content analysis and interpreted in convergence with statistical analysis of quantitative data in a mixed-methods design. Local guidelines concerning DW existed in 54% of the units. A BIS device was present in 52%, but only half of those units used it regularly, and no correlations to frequency of DW adjustments or BP were found. HD nurses were authorized to adjust DW in 60% of the units; in these units, the frequency of DW adjustments was 1.6 times higher and systolic BP pre-HD 8 mmHg lower. There is a wide variation in routines for DW determination, and there are indications that authorization of HD nurses to adjust DW may improve DW assessment. BIS is sparsely used; its implementation may have been delayed by uncertainty over how to manage the device and interpret measurements. Hence, better methods and guidelines for assessing DW and using BIS need to be developed.

Place, publisher, year, edition, pages
2016. Vol. 20, no 1, p. 111-119
Keywords [en]
Hemodialysis, dry weight, bioimpedance spectroscopy, guidelines, blood pressure, mixed-methods design
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-264132DOI: 10.1111/hdi.12336ISI: 000369304400022PubMedID: 26264888OAI: oai:DiVA.org:uu-264132DiVA, id: diva2:859130
Available from: 2015-10-06 Created: 2015-10-06 Last updated: 2020-04-03Bibliographically approved
In thesis
1. Fluid Management in Haemodialysis: Studies on current practices and new methods
Open this publication in new window or tab >>Fluid Management in Haemodialysis: Studies on current practices and new methods
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic fluid overload has been identified as an independent predictor of mortality in haemodialysis patients, and 30% remain fluid overloaded at dry weight. The use of bioimpedance spectroscopy (BIS) in fluid management may improve blood pressure control and cardiovascular status. However, the importance of regular and careful clinical assessment of fluid balance is repeatedly emphasised.

This thesis is based on five papers and the overall aim was to investigate current practices and new methods for fluid management in haemodialysis, and to develop a management tool for dry weight determination, based on multiple complementary methods. The purpose was to contribute to reduced prevalence of fluid overload and intradialytic symptoms in haemodialysis patients, by providing the healthcare team and the patient with a tool, that facilitates communication and enables informed decision-making in dry weight determination.

In the initial, cross-sectional study, clinical praxis for dry weight assessment in Sweden and Denmark was investigated. A wide variation in routines was found. Despite high access, BIS was sparsely used. Instead, nurses’ authorisation to adjust haemodialysis patients’ dry weight was associated with improved fluid status. The second study had a qualitative approach. Focus group interviews, with healthcare professionals, were carried out to achieve a deeper understanding of the factors preventing or facilitating the use of BIS. In the third study, the usefulness of a biomarker, brain natriuretic peptide (BNP), for assessing fluid status in haemodialysis patients, was investigated. An association between BNP and fluid overload was established. The between-individual variation in BNP levels was greater than the within-individual variation over time. Therefore, if BNP is to be used as a marker for fluid overload, repeated measurements are required. In the fourth study, we developed and validated a multifactorial decision aid, Recova®, that incorporates BIS in dry weight determination. Recova® is based on physiological parameters routinely measured in haemodialysis and provides guidance on when and how to respond to recognised fluid alterations. In the fifth study, the decision aid’s effect on volume status was tested in a cohort of haemodialysis patients. Implementation of Recova® had effect on fluid status symptoms, BIS-measured hydration status and NT-proBNP levels.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. p. 72
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1664
Keywords
Haemodialysis, Fluid management, Fluid overload, Bioimpedance spectroscopy, Dry weight, Brain natriuretic peptide, Decision aid
National Category
Urology and Nephrology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-407956 (URN)978-91-513-0935-4 (ISBN)
Public defence
2020-05-27, H:son Holmdahlssalen, Akademiska Sjukhuset, Ingång 100, 2 tr, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-05-06 Created: 2020-04-03 Last updated: 2020-05-06

Open Access in DiVA

fulltext(480 kB)181 downloads
File information
File name FULLTEXT01.pdfFile size 480 kBChecksum SHA-512
e0bfe8d46bc415b1ffaf41c1330d1bd78b95db24a8858b1f92006666fc544f948f276cb85505615273563fb3929ea48a5fa6d6b18abe41a4131e08027dee2900
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Authority records BETA

Stenberg, JennyLindberg, MagnusFuruland, Hans

Search in DiVA

By author/editor
Stenberg, JennyLindberg, MagnusFuruland, Hans
By organisation
Renal MedicineCaring Sciences
In the same journal
Hemodialysis International
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 181 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 481 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf