Kidney medicine · 2025
Reducing Excessive Interdialytic Weight Gain in Young Hemodialysis Patients: A Quality Improvement Initiative.
СтатьяНазвание и аннотация: Перевод в очереди
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Al Barbandi Malek, DeFreitas Marissa J, Katsoufis Chryso P, Santos Liz Bayes, Sigurjonsdottir Vaka, Ridore Michelande, Jackson Beverley, Vaccaro Daniela Safina, Weir Janette, Oliva Melisa, Ospina Clara Lora, Seeherunvong Wacharee, Chandar Jayanthi C, Abitbol Carolyn L
Аннотация
RATIONALE & OBJECTIVE: Excessive interdialytic weight gain (IDWG) is associated with increased cardiovascular risk in hemodialysis patients. We aimed to reduce excessive IDWG events by 50% over 2 years using a multi-interventional quality improvement approach.
STUDY DESIGN: Prospective, single-center, multimodal quality improvement initiative using Plan-Do-Study-Act cycles.
SETTING & PARTICIPANTS: All pediatric and young adult patients (<27 years old) receiving outpatient hemodialysis at a single pediatric dialysis center (n = 17; 4,166 sessions) from June 2020 to June 2022.
EXPOSURES: Interventions included individualized chairside education, dialysis nurse-driven patient communication, monthly IDWG tracking in team meetings, and a reduction in dialysate sodium concentration from 140 to 137 mEq/L.
OUTCOMES: The primary outcome was percent of hemodialysis sessions with excessive IDWG (≥5%). Balancing measures included additional dialysis sessions, serum sodium levels, blood pressure trends, and dialysis nurse documentation burden.
ANALYTICAL APPROACH: Statistical process control charts assessed outcome trends. t Test compared pre- and postintervention data. Statistical process control chart centerlines and control limits identified special cause variation.
RESULTS: At baseline, 39% of dialysis sessions showed excessive IDWG. Following the full implementation of interventions, the mean shifted to 19%, representing a 51% reduction. The dialysate sodium change and nurse-driven communication had the greatest impact. There were no significant changes in blood pressure, serum sodium, or additional dialysis sessions. Documentation time added per session averaged <3 minutes.
LIMITATIONS: We did not extract patient-level clinical data such as baseline hypertension, cardiac comorbid conditions, adherence metrics, level of engagement in psychology, or antihypertensive medication adjustments.
CONCLUSIONS: A multidisciplinary, multimodal quality improvement intervention significantly reduced the frequency of excessive IDWG in pediatric dialysis patients. Lowering dialysate sodium and nurse-led counseling were particularly impactful without increasing treatment burden. Future work should focus on sustainability, behavioral health integration, and long-term cardiovascular outcomes.
STUDY DESIGN: Prospective, single-center, multimodal quality improvement initiative using Plan-Do-Study-Act cycles.
SETTING & PARTICIPANTS: All pediatric and young adult patients (<27 years old) receiving outpatient hemodialysis at a single pediatric dialysis center (n = 17; 4,166 sessions) from June 2020 to June 2022.
EXPOSURES: Interventions included individualized chairside education, dialysis nurse-driven patient communication, monthly IDWG tracking in team meetings, and a reduction in dialysate sodium concentration from 140 to 137 mEq/L.
OUTCOMES: The primary outcome was percent of hemodialysis sessions with excessive IDWG (≥5%). Balancing measures included additional dialysis sessions, serum sodium levels, blood pressure trends, and dialysis nurse documentation burden.
ANALYTICAL APPROACH: Statistical process control charts assessed outcome trends. t Test compared pre- and postintervention data. Statistical process control chart centerlines and control limits identified special cause variation.
RESULTS: At baseline, 39% of dialysis sessions showed excessive IDWG. Following the full implementation of interventions, the mean shifted to 19%, representing a 51% reduction. The dialysate sodium change and nurse-driven communication had the greatest impact. There were no significant changes in blood pressure, serum sodium, or additional dialysis sessions. Documentation time added per session averaged <3 minutes.
LIMITATIONS: We did not extract patient-level clinical data such as baseline hypertension, cardiac comorbid conditions, adherence metrics, level of engagement in psychology, or antihypertensive medication adjustments.
CONCLUSIONS: A multidisciplinary, multimodal quality improvement intervention significantly reduced the frequency of excessive IDWG in pediatric dialysis patients. Lowering dialysate sodium and nurse-led counseling were particularly impactful without increasing treatment burden. Future work should focus on sustainability, behavioral health integration, and long-term cardiovascular outcomes.