Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Department of Caring Sciences, University of Gävle, Gävle, Sweden.
Ups J Med Sci. 2020 Nov;125(4):281-292. doi: 10.1080/03009734.2020.1804495. Epub 2020 Aug 27.
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.
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.
Forty-nine patients at two haemodialysis units were enrolled. In participants with fluid overload ( = 10), both overhydration and fluid overload symptom score decreased. In fluid-depleted participants ( = 20), target weight adjustment frequency and the estimated target weight increased. The post-dialytic negative overhydration was reduced, but NT-proBNP increased.
Implementation of Recova in haemodialysis care increased the monthly frequencies of bioimpedance measurements and target weight adjustments, and it contributed to symptom reduction.
The Uppsala County Council Registry of Clinical Trials: FoU 2019-0001-15.
液体超负荷与血液透析患者的死亡率相关，且 30%的患者在透析后仍处于液体超负荷状态。本研究旨在评估 Recova（一种将临床评估与生物阻抗光谱相结合的决策辅助工具）的应用是否有助于确定个体化目标体重，从而改善维持性血液透析患者的液体状态。
通过研究结束时达到适当目标体重的参与者比例来衡量实施效果，评估指标包括症状、水合状态和 N 末端脑利钠肽前体（NT-proBNP）的变化。护士被指示每两周使用 Recova 一次，干预过程的评估指标包括液体状态评估、生物阻抗测量和目标体重调整的频率。
两个血液透析中心共纳入了 49 名患者。在液体超负荷的参与者（n=10）中，均出现了脱水和液体超负荷症状评分的降低。在液体耗竭的参与者（n=20）中，目标体重调整的频率和估计的目标体重增加。透析后负性脱水减少，但 NT-proBNP 增加。
Recova 在血液透析护理中的应用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。
乌普萨拉郡议会临床试验注册处：FoU 2019-0001-15。
