Abstract

Background

Fluid overload is associated with mortality in haemodialysis patients, and 30% of patients remain fluid-overloaded after dialysis. The aim of this study was to evaluate if implementation of Recova^®, a decision aid combining clinical assessment with bioimpedance spectroscopy, facilitates individualization of target weight determination and thereby contributes to improved fluid status in maintenance haemodialysis patients.

Methods

The impact of the implementation was measured as the proportion of participants at an adequate target weight at the end of the study, assessed as change in symptoms, hydration status, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Nurses were instructed to use Recova every 2 weeks, and the process of the intervention was measured as frequencies of fluid status assessments, bioimpedance measurements, and target weight adjustments.

Results

Forty-nine patients at two haemodialysis units were enrolled. In participants with fluid overload (n = 10), both overhydration and fluid overload symptom score decreased. In fluid-depleted participants (n = 20), target weight adjustment frequency and the estimated target weight increased. The post-dialytic negative overhydration was reduced, but NT-proBNP increased.

Conclusions

Implementation of Recova in haemodialysis care increased the monthly frequencies of bioimpedance measurements and target weight adjustments, and it contributed to symptom reduction.

Trial registration

The Uppsala County Council Registry of Clinical Trials: FoU 2019-0001-15.

中文翻译：

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实施决策辅助以识别和纠正血液透析患者的容量变化 (Recova®)。

摘要

背景

液体超负荷与血液透析患者的死亡率相关，30% 的患者在透析后仍处于液体超负荷状态。本研究的目的是评估 Recova ^®（一种结合临床评估与生物阻抗谱的决策辅助工具）的实施是否有助于目标体重确定的个体化，从而有助于改善维持性血液透析患者的体液状态。

方法

实施的影响被衡量为研究结束时达到足够目标体重的参与者比例，评估为症状、水合状态和 N 端脑钠肽前体 (NT-proBNP) 的变化。护士被指示每 2 周使用一次 Recova，干预过程通过体液状态评估、生物阻抗测量和目标体重调整的频率进行测量。

结果

入组了两个血液透析单位的 49 名患者。在液体超负荷的参与者 ( n  = 10) 中，水分过多和液体超负荷症状评分均下降。在液体耗尽的参与者 ( n  = 20) 中，目标体重调整频率和估计的目标体重增加。透析后负性过度水化减少，但 NT-proBNP 增加。

结论

Recova 在血液透析护理中的实施增加了每月生物阻抗测量和目标体重调整的频率，并有助于减轻症状。

试用注册

乌普萨拉县议会临床试验登记处：FoU 2019-0001-15。