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Clinical Trial
. 2020 Nov;125(4):281-292.
doi: 10.1080/03009734.2020.1804495. Epub 2020 Aug 27.

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

Jenny Stenberg  1 , Magnus Lindberg  2   3 , Hans Furuland  1
Affiliations
Clinical Trial

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

Jenny Stenberg et al. Ups J Med Sci. 2020 Nov.

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.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
The Recova® scoring system for systemized clinical assessment of fluid status (from Reference [18]). The symptom score can total 0–16 points: 0–8 fluid overload points and 0–8 fluid depletion points.
Figure 2.
Figure 2.
Bioimpedance-measured median overhydration (OH) post in the four groups at baseline and at end-of-study.
Figure 3.
Figure 3.
Comparison of distribution of pre-dialysis fluid symptom status in each group (frequencies), at baseline (BL) and at end-of-study (End).
See this image and copyright information in PMC

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