Implementation of a decision aid for recognition and correction of volume alterations (Recova^®) in haemodialysis patients

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.

Keywords:

• Body composition
• body fluids
• decision support techniques
• electric impedance
• prospective studies
• renal dialysis
• water–electrolyte imbalance

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This study was partially funded by grants from the CUWX Counties Renal Patients’ Foundation, and the Uppsala County Council. The funding sources were not involved in the study design, the collection, analysis, and interpretation of data, the writing process, or the decision to submit the article for publication.

Notes on contributors

Jenny Stenberg

Jenny Stenberg is a registered nurse, who obtained a PhD in Medical Sciences in 2020 at the Department of Medical Sciences, Uppsala University. She is employed at the Renal Medicine Department at the University Hospital of Uppsala and is specialized in haemodialysis.

Magnus Lindberg

Magnus Lindberg is a registered nurse who has worked in renal care for 25 years, mostly within the haemodialysis setting. Currently he is an Associate Professor in Caring Sciences at University of Gävle, Faculty of Health and Occupational Studies, Sweden.

Hans Furuland

Hans Furuland is a medical doctor and has a PhD in nephrology at the Department of Medical sciences, Uppsala University. He has been a practising clinical nephrologist for almost 30 years at the Renal Unit, Uppsala University, serving as the head of the unit for 10 of those years. He practizes in all fields of nephrology, with special emphasis on dialysis. Research interests lies within haemodialysis, diabetic nephropathy, hyperkalaemia, anaemia, and chronic inflammation.