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Systematic fluid assessment in haemodialysis: Development and validation of a decision aid
Uppsala universitet.
Department of Renal Medicine, Leeds Teaching Hospitals Trust Leeds, United Kingdom.
University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala universitet.ORCID iD: 0000-0003-1289-9896
Uppsala universitet.
2020 (English)In: Journal of Renal Care, ISSN 1755-6678, E-ISSN 1755-6686, Vol. 46, no 1, p. 52-61Article in journal (Refereed) Published
Abstract [en]

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

METHODS: The decision aid was based on empirical experience and a literature review identifying physiological parameters already used in the clinical assessment of fluid status. Content validity was established by patient representatives, interdisciplinary stakeholders and external experts, who assessed item relevance and comprehensiveness. Reliability was assessed by 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 scoring system; (2) thresholds and triggers; (3) a decision aid algorithm. Agreement between raters in the assessment of symptoms was almost perfect, with Intraclass Correlation Coefficient > 0.90. Agreement in clinical response was only fair, but increased to 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 clinical practice will require training of staff. Clinical intervention studies are required to evaluate if RECOVA facilitates response to and correction of recognised fluid alterations.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020. Vol. 46, no 1, p. 52-61
Keywords [en]
Bioimpedance, Fluid management, Haemodialysis, Overhydration, Validation
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:hig:diva-30913DOI: 10.1111/jorc.12304ISI: 000493824500001PubMedID: 31682083Scopus ID: 2-s2.0-85074763845OAI: oai:DiVA.org:hig-30913DiVA, id: diva2:1371721
Available from: 2019-11-20 Created: 2019-11-20 Last updated: 2020-03-20Bibliographically approved

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