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  • 1.
    Lindberg, Magnus
    Uppsala universitet.
    Monitoring and blunting styles in fluid restriction consultation2012Ingår i: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 16, nr 2, s. 282-285Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Excessive fluid overload is common in hemodialysis patients. Understanding fluid intake behavior in relation to used cognitive coping style would serve the fluid restriction consultation. The aim of this study was to explore whether hemodialysis patients' fluid intake behavior differs as a function of used coping style. Secondary analysis of data from 51 hemodialysis patients regarding cognitive coping style (assessed by the Threatening Medical Situations Inventory) and fluid intake behavior were used. The participants' mean age was 62.9 years (range 27-84), they had received dialysis treatment for 3.9 years on average (range 0-22), 63% were male and they had gained 3.6% (±1.3) of their dry body weight during the interdialytic period. There was a significant difference in fluid intake behavior between coping groups (F = 3.899, d.f. 2, P = 0.027). The difference (P = 0.028) was isolated between patients with cognitive blunting style and patients with neutral coping style. Identification of hemodialysis patients using cognitive avoidance strategies can be advantageous in renal care. Fluid advice provided may have to be adjusted to the used coping style, especially for patients with a blunting coping style. However, the findings need to be confirmed, and the effect of individualized counseling needs to be evaluated in forthcoming studies.

  • 2.
    Lindberg, Magnus
    et al.
    Högskolan i Gävle, Institutionen för vårdvetenskap och sociologi, Ämnesavdelningen för vårdvetenskap. entre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Prütz, Karl-Göran
    Department ofNephrology and Transplantation, Malmö University Hospital, Malmö, Sweden.
    Lindberg, Per
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Wikström, Björn
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Interdialytic weight gain and ultrafiltration rate in hemodialysis: lessons about fluid adherence from a national registry of clinical practice2009Ingår i: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 13, nr 2, s. 181-188Artikel i tidskrift (Refereegranskat)
    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.

  • 3.
    Stenberg, Jenny
    et al.
    Department of Medical Sciences, University Hospital, Uppsala, Sweden.
    Lindberg, Magnus
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Furuland, Hans
    Department of Medical Sciences, University Hospital, Uppsala, Sweden.
    Clinical praxis for assessment of dry weight in Sweden and Denmark: a mixed-methods study2016Ingår i: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 20, nr 1, s. 111-119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Overhydration is an independent predictor of mortality in hemodialysis (HD) patients. More than 30% of HD patients are overhydrated, motivating the development of new methods for assessing hydration status. This study surveyed clinical praxis and local guidelines for dry weight (DW) assessment in Swedish and Danish HD units, and examined if differences in routines and utilization of bioimpedance spectroscopy (BIS) and other assistive technology affected frequency of DW adjustments and blood pressure (BP) levels. Cross-sectional information on praxis, guidelines and routines, plus treatment-related data from 99 stratified patients were collected. Qualitative data were analyzed with content analysis and interpreted in convergence with statistical analysis of quantitative data in a mixed-methods design. Local guidelines concerning DW existed in 54% of the units. A BIS device was present in 52%, but only half of those units used it regularly, and no correlations to frequency of DW adjustments or BP were found. HD nurses were authorized to adjust DW in 60% of the units; in these units, the frequency of DW adjustments was 1.6 times higher and systolic BP pre-HD 8 mmHg lower. There is a wide variation in routines for DW determination, and there are indications that authorization of HD nurses to adjust DW may improve DW assessment. BIS is sparsely used; its implementation may have been delayed by uncertainty over how to manage the device and interpret measurements. Hence, better methods and guidelines for assessing DW and using BIS need to be developed.

  • 4.
    Stenberg, Jenny
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Melin, Jan
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Lindberg, Magnus
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för vårdvetenskap, Med-Vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Furuland, Hans
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients2019Ingår i: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 23, nr 3, s. 402-413Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Fluid management in hemodialysis patients is a controversial topic. Brain natriuretic peptide (BNP) is secreted from the heart in response to volume overload, and may be a marker of overhydration in hemodialysis patients. Our aim was to investigate the correlation between BNP and overhydration in a cohort of hemodialysis patients, and to find out whether BNP and overhydration correlate in repeated measurements within individuals with elevated BNP.

    METHODS: The study was prospective, observational, and had a cross-sectional part and a longitudinal follow-up. The distribution of BNP was investigated in a cohort of 64 hemodialysis patients. Blood samples and bioimpedance spectroscopy measurements were performed before midweek dialysis. Subsequently, 11 study participants with elevated BNP concentrations (>500 pg/mL) were assessed in another nine dialysis sessions each. These individuals also had their cardiac function and heart rate variability (HRV) examined.

    FINDINGS: BNP was above 500 pg/mL in 38% of the participants, and correlated positively with overhydration (rs = 0.381), inflammation and malnutrition, but not with systolic blood pressure. In comparison to participants with BNP below 500 pg/mL, participants with elevated BNP were older, had lower muscle strength, lower bodyweight and lower levels of hemoglobin and albumin. Echocardiography revealed cardiac anomalies in all 11 participants in the longitudinal follow-up, and HRV, as measured by SDNN, was pathologically low. In repeated measurements, the between-individuals variation of BNP in relation to overhydration was greater (SD = 0.581) than the within-person variation (SD = 0.285).

    DISCUSSION: BNP correlates positively to overhydration, malnutrition, and inflammation. In a subgroup of patients with elevated BNP, who are mainly elderly and frail, BNP reflects individual variation in hydration status, and hence seems to be a modifiable marker of overhydration. These data suggest that BNP is best applied for measuring changes in hydration status within an individual over time.

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