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Interdialytic weight gain and ultrafiltration rate in hemodialysis: lessons about fluid adherence from a national registry of clinical practice
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. (Caring Sciences)ORCID iD: 0000-0003-1289-9896
Malmö University Hospital.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
2009 (English)In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 13, no 2, 181-188 p.Article in journal (Refereed) Published
Abstract [en]

Excessive interdialytic weight gain (IWG) and ultrafiltration rates (UFR) above 10 mL/h/kg body weight imply higher morbidity and mortality. This study aimed to estimate the prevalence of high fluid consumers, describe UFR patterns, and describe patient characteristics associated with IWG and UFR. The Swedish Dialysis DataBase and The Swedish Renal Registry of Active Treatment of Uremia were used as data sources. Data were analyzed from patients aged >/=18 on regular treatment with hemodialysis (HD) and registered during 2002 to 2006. Interdialytic weight gain and dialytic UFR were examined in annual cohorts and the records were based on 9693 HD sessions in 4498 patients. Differences in proportions were analyzed with the chi-square test and differences in means were tested using the ANOVA or the t test. About 30% of the patients had IWG that exceed 3.5% of dry body weight and 5% had IWG >/=5.7%. The volume removed during HD was >10 mL/h/kg for 15% to 23% of the patients, and this rate increased during the first dialytic year. Patient characteristics associated with fluid overload were younger age, lower body mass index, longer dialytic vintage, and high blood pressure. By studying IWG and dialytic UFR as quality indicators, it is shown that there is a potential for continuing improvement in the care of patients in HD settings, i.e., to enhanced adherence to fluid restriction or alternatively to extend the frequency of dialysis for all patients, e.g., by providing daily treatment.

Place, publisher, year, edition, pages
2009. Vol. 13, no 2, 181-188 p.
Keyword [en]
Fluid adherence, hemodialysis, SDDB, SRAU, ultrafiltration, weight gain
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-101044DOI: 10.1111/j.1542-4758.2009.00354.xISI: 000265425700008PubMedID: 19432692OAI: oai:DiVA.org:uu-101044DiVA: diva2:211608
Available from: 2009-04-16 Created: 2009-04-16 Last updated: 2017-12-13
In thesis
1. Excessive Fluid Overload Among Haemodialysis Patients: Prevalence, Individual Characteristics and Self-regulation of Fluid Intake
Open this publication in new window or tab >>Excessive Fluid Overload Among Haemodialysis Patients: Prevalence, Individual Characteristics and Self-regulation of Fluid Intake
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is comprised of four studies and concerns haemodialysis patients’ confidence in being able to manage fluid intake between treatment sessions, and whether the fluid intake is influenced by certain modifiable characteristics of the persons in question. The overall aim was to study aspects of excessive fluid overload and haemodialysis patients’ self-regulation of fluid allotment from a bio-psychosocial and behavioural medicine perspective.

The extent of non-adherence to fluid allotment was described in Study I. National registry data were used. Three out of ten Swedish haemodialysis patients had excessive fluid overload and one out of five was at risk for treatment related complications due to too rapid ultrafiltration rate.

The objective in Study II was to develop and psychometrically evaluate a self-administered scale to measure situation-specific self-efficacy to low fluid intake. The measure (the Fluid Intake Appraisal Inventory) was found to be reliable and valid in haemodialysis settings.

Subgroups based on individual profiles of self-efficacy, attentional style and depressive symptoms were explored in Study III using a cluster analytic approach. Three distinct subgroups were found and the subgroup structure was validated for clinical relevance. The individuals’ profile concerning self-efficacy, attentional style and depressive symptoms has to be taken into account in nursing interventions designed to reduce haemodialysis patients’ fluid intake.

In Study IV, an intervention designed to reduce haemodialysis patients’ fluid intake was introduced and its acceptability, feasibility and efficacy were evaluated and discussed. Acceptability of such an intervention was confirmed. Addressing beliefs, behaviours, emotions and physical feelings is clinically feasible and may reduce haemodialysis patient’s excessive fluid overload.

This thesis indicates that there is a potential for improvement in the fluid management care of haemodialysis patients. Behavioural nursing strategies that aim to assist patients to achieve fluid control should be applied more extensively. Cognitive profiles of the patients should be taken into account when targeted nursing intervention aiming to encourage and maintain the patient’s fluid control is introduced.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 89 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 551
Keyword
Behavioural medicine, fluid overload, adherence, haemodialysis, self-efficacy, attentional style, depressive symptomatology, cluster analysis, tailored treatment, quasi-experimental single-case design, Fluid Intake Appraisal Inventory (FIAI), renal nursing
National Category
Urology and Nephrology Nursing
Research subject
Medical Science; Caring Sciences
Identifiers
urn:nbn:se:uu:diva-121983 (URN)978-91-554-7782-0 (ISBN)
Public defence
2010-05-19, Sal IV, Universitetshuset, Övre Slottsgatan 2, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-04-28 Created: 2010-04-03 Last updated: 2010-04-28Bibliographically approved

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