Patient Perspectives of target weight management and ultrafiltration during haemodialysis.

Patient perspectives of target weight management and ultrafiltration during haemodialysis.

Project Lead and Organisation

Dr David Keane, Leeds Teaching Hospitals NHS Trust

Clinical Requirement

Most haemodialysis patients accumulate fluid between treatments and the removal of this fluid is one of the primary functions of the treatment. Healthy kidneys remove fluid 24 hours a day, meaning that the rate of fluid removal is low at around 1 ml/min. In conventional thrice-weekly haemodialysis, all of the fluid accumulated between treatments must be removed in a four hour session, leading to much higher rates of fluid removal, typically around 6-12 ml/min (Saran, 2006).

The high rate of ultrafiltration is associated with acute symptoms such as cramping, dizziness, nausea and fatigue and with longer term complications such as myocardial stunning and increased cardiovascular mortality, brain and gut injury and loss of residual renal function (Oei, 2015; Burton, 2009; Eldehni 2012; McIntyre 2010; Lindley, 2014). An indirect consequence of these symptoms is the inability to remove sufficient fluid during a treatment leading to chronic fluid overload, associated with breathlessness, oedema and increased cardiovascular risk (Lindley 2014). It is not surprising that managing fluid removal in haemodialysis is seen as one of the biggest challenges to improving outcomes in this patient group.

Project

To develop a questionnaire that looks at patient’s feelings around the aspects of fluid management while they are on dialysis and use this questionnaire across four large renal units to allow us to see if there are differences between centres.

To use the findings to create a patient information leaflet to help explain things that are not well understood. The findings may also be used in further studies looking at improving fluid management and hopefully make sure patient perspectives are considered.

This study aims to provide some preliminary data around patient perspectives of fluid removal and target weight management in haemodialysis. Despite being a fundamental and vital component of patient care, there remains ambiguity around how best to manage fluid status. This is compounded by a distinct lack of information on patient’s perspectives of their target weight, of how and who decides on their target weight, what ultrafiltration volumes mean to them and how intradialytic symptoms are associated with target weight management.

To design, test and administer a questionnaire with haemodialysis patients to capture their perspectives of these themes. This data will be used to produce a patient information leaflet as an initial outcome. We hope that this has the potential to improve patient knowledge, improve clinician’s understanding of the patient perspective and promote shared decision making. It is hoped that this work can be followed up and extended to other patient groups, such as peritoneal dialysis patients, non-English speakers and further haemodialysis units.

Project management is provided through D4D which allows the majority of the administration relating to ethics approvals, coordination between centres and meeting deadlines to be effectively managed as well as dissemination.

Impact

Improving patient education and understanding around these issues will make the patient’s decisions more informed which could feasibly lead to a reduction in the many adverse effects of poor fluid management. A first step towards this aim is to attempt to capture information from patients about how much involvement they have in fluid management, how much they would like to have, what their current knowledge base is and what knowledge is lacking.

Partners

• Sheffield Teaching Hospitals NHS Foundation Trust (STH)
• NIHR Devices for Dignity HRC
• Leeds Teaching Hospitals NHS Trust
• University of Leeds (Psychology Department)
• Elaine Moore
• National Kidney Federation

Funding

This project is in receipt of £24,462 from the The Kidney Patient Research Partnership BKPA & British Renal Society Joint Grants Programme 2015.