Excess fluid volume: sociodemographic and clinical analysis in haemodialysis patients Fernandes MICD, et al.
INTRODUCTIONChronic kidney disease (CKD) is progressive and irreversible kidney damage and is associated with decreased glomerular filtration rate. The filtration and renal regulation failure generates the accumulation of toxic substances in the body, triggering water, electrolyte, acid-base, endocrine and metabolic disorders (1) . Therefore, performing treatments that replace kidney functions is needed. Accordingly, haemodialysis (HD) plays a primary role. At of the end of the year 2012, 3,010,000 patients worldwide had end-stage renal disease. Of these, 70% underwent haemodialysis (2) . This therapy consists of blood filtration with the aid of a dialysis machine, through a dialyser, in which toxic substances and excess nitrogen liquid are excreted, and the function of the renal glomeruli and tubules is supported (1) . Despite the appropriate follow-up, this treatment does not completely replace renal function and causes the accumulation of excreta nitrogen, fluids and electrolytes, which are responsible for signalling the signs and symptoms in this clientele (3)(4) . Amongst the effects of renal impairment, liquid accumulation is a central problem in these individuals. This excess is the response to the water imbalance between entry and output of the liquids in the organisms, causing complications such as cardiovascular problems (5) . In this context, nursing care needs to directly address the actual customer's needs during haemodialysis. The identification of nursing diagnoses (ND), a step of the nursing process that helps to organise and direct care, translates human responses experienced by the customer in relation to their health condition (6) . The International ND from NANDA International (NAN-DA-I) "Excess fluid volume" is defined as increased retention of isotonic liquids (7) . It comprises 25 defining characteristics and three related factors (7) . Studies with patients submitted to haemodialysis have indicated the high prevalence of this nursing diagnosis (8)(9) , having a prevalence of 82% in patients undergoing haemodialysis. Moreover, the following characteristics were significantly associated with this diagnosis: agitation, pulmonary congestion, jugular distension, oedema, altered electrolytes, weight gain, feed intake greater than the debt and adventitious breath sounds (10) . Another study confirmed the above research and suggested that water retention is common in haemodialysis patients and is associated with worse outcomes, including various heart conditions such as tissue ischemia, arrhythmia and sudden cardiac death, in addition to acute pulmonary oedema and hypertension. Hypertension is an important risk factor for cardiovascular disease, which is commonly seen in populations with declining renal function (11)(12)(13) . Accordingly, the onset of renal replacement therapy partially decreases the symptoms of failing kidneys; however, high blood pressure levels persist in most patients...
