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The efficacy of managing fluid overload in chronic peritoneal dialysis patients by a structured nurse-led intervention protocol.

ABSTRACT: BACKGROUND:Extracellular volume overload is a common problem in peritoneal dialysis (PD) patients and is associated with excessive mortality. We determine the effectiveness of treating PD patients with extracellular volume overload by a structured nurse-led intervention program. METHODS:The hydration status of PD patients was screened by bioimpedance spectroscopy (BIS). Fluid overload was defined as overhydration volume???2?L. Patients were classified into Symptomatic and Asymptomatic Groups and were managed by a structured nurse-led intervention protocol that focused on education and motivation. Hypertonic cycles were given for short term symptom relief for the Symptomatic group. Patients were followed for 12?weeks for the change in volume status, blood pressure, knowledge and adherence as determined by standard questionnaires. RESULTS:We recruited 103 patients (53 Symptomatic, 50 Asymptomatic Group. There was a significant reduction in overhydration volume 4?weeks after intervention, which was sustained by week 12; the overall reduction in overhydration volume was 0.96?±?1.43?L at 4?weeks, and 1.06?±?1.70?L at 12?weeks (p?

SUBMITTER: Law MC

PROVIDER: S-EPMC6902497 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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The efficacy of managing fluid overload in chronic peritoneal dialysis patients by a structured nurse-led intervention protocol.

Law Man Ching MC Kwan Bonnie Ching-Ha BC Fung Janny Suk-Fun JS Chow Kai Ming KM Ng Jack K C JKC Pang Wing-Fai WF Cheng Phyllis Mei-Shan PM Leung Chi Bon CB Szeto Cheuk Chun CC

BMC nephrology 20191209 1

<h4>Background</h4>Extracellular volume overload is a common problem in peritoneal dialysis (PD) patients and is associated with excessive mortality. We determine the effectiveness of treating PD patients with extracellular volume overload by a structured nurse-led intervention program.<h4>Methods</h4>The hydration status of PD patients was screened by bioimpedance spectroscopy (BIS). Fluid overload was defined as overhydration volume ≥ 2 L. Patients were classified into Symptomatic and Asymptom ...[more]

PMID: 31815632

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Project description:Introduction: Preservation of peritoneal function is essential in long-term peritoneal dialysis. Biocompatible dialysis solutions might prevent or postpone the membrane alteration resulting in ultrafiltration failure and consecutive morbidity and mortality.Methods: We conducted an observational cohort study in which we made a longitudinal comparison between the course of peritoneal solute and fluid transport during treatment with conventional and biocompatible solutions. Therefore, prospectively collected peritoneal transport data from the yearly standard peritoneal permeability analysis were analyzed in 251 incident patients treated between 1994 and censoring in 2016. Fluid transport included small pore and free water transport. Solute transport was assessed by creatinine mass transfer area coefficient and glucose absorption. Linear mixed models including change point analyses were performed. Interaction with peritonitis was examined.Results: One hundred thirty-five patients received conventional and 116 biocompatible solutions. Sixty-seven percent (conventional) and 64% (biocompatible) of these underwent minimally three transport measurements. Initially, biocompatible fluids showed higher small solute transport and lower ultrafiltration than conventional fluids up to 3 years. Thereafter, conventional fluids showed an increase in small solute transport (+2.7 ml/min per year; 95% confidence interval [CI]: 0.9 to 4.5) and a decrease of free water transport (-28.0 ml/min per year; 95% CI: -60.4 to 4.4). These were minor or absent in biocompatible treatment. Peritonitis induced a decrease of transcapillary ultrafiltration after 2 years on dialysis with conventional solutions (-291 ml/min per year; 95% CI: -550 to -32) while this was absent in biocompatible treatment.Conclusion: Despite a higher initial solute transport with biocompatible solutions, these have less influence on functional long-term peritoneal alterations than conventional solutions.

Dataset Information

The efficacy of managing fluid overload in chronic peritoneal dialysis patients by a structured nurse-led intervention protocol.

Publications

The efficacy of managing fluid overload in chronic peritoneal dialysis patients by a structured nurse-led intervention protocol.

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