The Frustrating Attempt to Limit the Interdialytic Weight Gain in Patients on Chronic Hemodialysis: New Insights Into an Old Problem

Bossola, Maurizio; Pepe, Gilda; Vulpio, Carlo

doi:10.1053/j.jrn.2018.01.015

Cited by 41 publications

(44 citation statements)

References 74 publications

(73 reference statements)

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“…These reductions in sodium intake corresponded to reductions in IDWG of −0.8 + 0.2 kg and − 0.5 ± 0.6 kg, respectively. Unfortunately, these studies have not been published as full peer reviewed journal articles and no long‐term randomized control trial has shown sustained reductions in dietary sodium intake and IDWG 16 . Our volume control protocol also did not produce reductions in either SBP or DBP.…”

Section: Discussionmentioning

confidence: 81%

Pilot feasibility study examining the effects of a comprehensive volume reduction protocol on hydration status and blood pressure in hemodialysis patients

Perez

Burrows

Chan

et al. 2020

Hemodialysis International

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Introduction Chronic volume overload is a persistent problem in hemodialysis (HD) patients. The purpose of this study was to investigate the impacts of comprehensive volume reduction protocol on HD patient's hydration status and blood pressure (BP). Methods Twenty‐three HD patients (age = 55.7 ± 13.3 years) completed a 6‐month comprehensive volume control protocol consisting of: reducing postdialysis weight; reducing BP medication prescriptions; and weekly intradialytic counseling to reduce dietary sodium intake and interdialytic weight gain (IDWG). The primary outcome was volume overload (VO) measured by bioelectrical impedance spectroscopy. Secondary outcomes included: IDWG, postdialysis weight, estimated dry weight (EDW), dietary sodium intake, BP and BP medication prescriptions. Findings From baseline (0M) to 6 months (6M), significant improvements were noted in: VO (0M 3.9 ± 3.9 L vs. 6M 2.6 ± 3.4 L, P = 0.003), postdialysis weight (0M 89.4 ± 23.1 kg vs. 6M 87.6 ± 22.2 kg; P = 0.012), and EDW (0M 89.0 ± 23.2 vs. 6M 86.7 ± 22.5 kg., P = 0.009). There was also a trend for a reduction in monthly averaged IDWG (P = 0.053), and sodium intake (0M 2.9 ± 1.6 vs. 6M 2.3 ± 1.1 g/d, P = 0.125). Neither systolic BP (0M 162 ± 27 vs. 6M 157 ± 23 mmHg, P = 0.405) nor diastolic BP (0M 82 ± 21 vs. 6M 82 ± 19 mmHg, P = 0.960) changed, though there was a significant reduction in the total number of BP medications prescribed (0M 3.0 ± 1.0 vs. 6M 1.5 ± 1.0 BP meds; P = 0.004). Discussion Our volume reduction protocol significantly improved HD patient's hydration status. While BP did not change, the reduction in prescribed BP medication number suggests improved BP control. Despite these overall positive findings, the magnitude of change in most variables was modest. Comprehensive changes in HD clinics may be necessary to realize more clinically significant results.

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Section: Discussionmentioning

confidence: 81%

Pilot feasibility study examining the effects of a comprehensive volume reduction protocol on hydration status and blood pressure in hemodialysis patients

Perez

Burrows

Chan

et al. 2020

Hemodialysis International

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“…An average increase of 4%, 5%, and 6% was exhibited by 4, 3, and 1 participants, respectively. The IDWG should be lower than 4% of dry body weight 39 . Difficulty in maintaining weight during the HD period is a very common problem among many patients 7 .…”

Section: Discussionmentioning

confidence: 99%

The experience of adherence among hemodialysis patients undergoing therapeutic regimen: a qualitative study

et al. 2020

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Background: Hemodialysis is one of the most widely used renal replacement therapies and the most efficient procedure for managing patients with end-stage renal disease. It can reduce the symptoms of the disease; however, it affects quality of life, resulting in major changes to all areas of life. Thus, patients must adhere to the therapeutic regimen of hemodialysis. Knowledge regarding the adherence of hemodialysis patients to their therapeutic regimens and their experience is needed as it forms the basis for developing comprehensive nursing care and broader nursing practices for renal disease patients. This study aimed to explore patients’ experience of adherence to the therapeutic regimen. Methods: The design of this study was formulated using a qualitative phenomenological approach with a purposive sampling method that involved interviewing 10 selected patients. Data analysis was performed using the Colaizzi method. Results: The results of this study revealed five themes: (1) the most difficult period is the beginning of the hemodialysis program; (2) it is important for patients to perform self-care; (3) nurses play a critical role in improving adherence; (4) there is a decrease in patients’ ability to perform physical activity; and (5) there are supporting and inhibiting factors of adherence to the therapeutic regimens in hemodialysis patients. Conclusions: Adherence to the therapeutic regimen fluctuates. Thus, there is a need to optimize the role of nurses in improving adherence.

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“…High IDWG is associated with higher risk of all-cause and cardiovascular death and increased morbidity, such as ventricular hypertrophy and major adverse cardiac and cerebrovascular events [3][4][5][6][7][8][9]. In addition, it leads to supplementary weekly dialysis sessions with consequent deterioration of quality of life and increased costs [10].…”

Section: Introductionmentioning

confidence: 99%

“…Adherence to a low-salt diet of hemodialysis patients is poor [18] as well as in patients with other chronic diseases such as heart failure, hypertension, and cirrhosis [19][20][21][22][23][24][25][26][27]. Many factors contribute to such poor adherence such as lack of knowledge, interference with socialization, low education level, low socioeconomic status, and lack of food selections [10]. It must also be considered that hemodialysis patients are continuously instructed to follow a restricted diet because of potassium and phosphorus concerns, and such further restrictions may lead to a diet poorly acceptable in terms of palatability and pleasantness.…”

Section: Introductionmentioning

confidence: 99%

Dietary Daily Sodium Intake Lower than 1500 mg Is Associated with Inadequately Low Intake of Calorie, Protein, Iron, Zinc and Vitamin B1 in Patients on Chronic Hemodialysis

et al. 2020

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Background: To measure daily sodium intake in patients on chronic hemodialysis and to compare the intake of nutrients, minerals, trace elements, and vitamins in patients who had a daily sodium intake below or above the value of 1500 mg recommended by the American Heart Association. Methods: Dietary intake was recorded for 3 days by means of 3-day diet diaries in prevalent patients on chronic hemodialysis. Each patient was instructed by a dietitian on how to fill the diary, which was subsequently signed by a next of kin. Results: We studied 127 patients. Mean sodium intake (mg) was 1295.9 ± 812.3. Eighty-seven (68.5%) patients had a daily sodium intake <1500 mg (group 1) and 40 (31.5%) ≥ 1500 mg (group 2). Correlation between daily sodium intake and daily calorie intake was significant (r = 0.474 [0.327 to 0.599]; p < 0.0001). Daily calorie intake (kcal/kg/day) was lower in group 1 (21.1 ± 6.6; p = 0.0001) than in group 2 (27.1 ± 10.4). Correlation between daily sodium intake and daily protein intake was significant (r = 0.530 [0.392 to 0.644]; p < 0.0001). The daily protein intake (grams/kg/day) was lower in group 1 (0.823 ± 0.275; p = 0.0003) than in group 2 (1.061 ± 0.419). Daily intake of magnesium, copper, iron, zinc, and selenium was significantly lower in group 1 than in group 2. Daily intake of vitamin A, B2, B3, and C did not differ significantly between group 1 and group 2. Daily intake of vitamin B1 was significantly lower in group 1 than in group 2. Significantly lower was, in group 1 than in group 2, the percentage of patients within the target value with regard to intake of calories (11.5% vs. 37.5%; p = 0.001) and proteins (9.2% vs. 27.5%; p = 0.015) as well as of iron (23% vs. 45%; p = 0.020), zinc (13.8% vs. 53.8%; p = 0.008) and vitamin B1 (8.1% vs. 50%; p < 0.001). Conclusion: A low daily intake of sodium is associated with an inadequately low intake of calorie, proteins, minerals, trace elements, and vitamin B1. Nutritional counselling aimed to reduce the intake of sodium in patients on chronic hemodialysis should not disregard an adequate intake of macro- and micronutrients, otherwise the risk of malnutrition is high.

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The Frustrating Attempt to Limit the Interdialytic Weight Gain in Patients on Chronic Hemodialysis: New Insights Into an Old Problem

Cited by 41 publications

References 74 publications

Pilot feasibility study examining the effects of a comprehensive volume reduction protocol on hydration status and blood pressure in hemodialysis patients

Pilot feasibility study examining the effects of a comprehensive volume reduction protocol on hydration status and blood pressure in hemodialysis patients

The experience of adherence among hemodialysis patients undergoing therapeutic regimen: a qualitative study

Dietary Daily Sodium Intake Lower than 1500 mg Is Associated with Inadequately Low Intake of Calorie, Protein, Iron, Zinc and Vitamin B1 in Patients on Chronic Hemodialysis

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