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Systematic fluid assessment in haemodialysis: Development and validation of a decision aid
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Renal Medicine. (Njurmedicin)ORCID iD: 0000-0003-2408-0087
Leeds Teaching Hosp Trust Leeds, Dept Renal Med, Leeds, W Yorkshire, England.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Gavle, Dept Hlth & Caring Sci, Gavle, Sweden.ORCID iD: 0000-0003-1289-9896
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Renal Medicine. (Njurmedicin)
(English)In: Journal of Renal Care, ISSN 1755-6678, E-ISSN 1755-6686Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background

About a third of patients undergoing haemodialysis have poorly controlled fluid status, which may affectsurvival. Clinical assessment is subjective and imprecise, which has led to the increasing use of devices based on bioimpedancespectroscopy (BIS). However, BIS cannot provide a simple target applicable to all patients. Our aim was to developand validate a decision aid combining clinical assessment of fluid status with information from BIS in target weightdetermination.

Methods

The decision aid was based on empirical experience and a literature review identifying physiological parametersalready used in the clinical assessment of fluid status. Content validity was established by patient representatives, interdisciplinarystakeholders and external experts, who assessed item relevance and comprehensiveness. Reliability was assessedby inter‐rater agreement analysis between nurses assessing typical patient cases.

Results

The decision aid for Recognition and Correction of Volume Alterations (RECOVA) consists of three parts (1) a scoringsystem; (2) thresholds and triggers; (3) a decision aid algorithm. Agreement between raters in the assessment of symptomswas almost perfect, with Intraclass Correlation Coefficient > 0.90. Agreement in clinical response was only fair, but increasedto moderate, with training and self‐reported confidence.

Conclusion

RECOVA may enable systematic clinical assessment of fluid status, facilitating early recognition of fluid alterations,and incorporation of bioimpedance into target weight management. However, implementation into clinicalpractice will require training of staff. Clinical intervention studies are required to evaluate if RECOVA facilitates response toand correction of recognised fluid alterations.

Keywords [en]
Bioimpedance, Fluid management, Haemodialysis, Overhydration, Validation
National Category
Urology and Nephrology
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-396814DOI: DOI:10.1111/jorc.12304ISI: 000493824500001PubMedID: 31682083OAI: oai:DiVA.org:uu-396814DiVA, id: diva2:1369145
Available from: 2019-11-11 Created: 2019-11-11 Last updated: 2019-11-25Bibliographically approved

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