Effect of the fluid management nursing intervention on improving biochemical test results and dialysis therapy in chronic kidney disease patients: a randomized controlled trial
DOI:
https://doi.org/10.17533/udea.iee.v43n3e12Keywords:
renal insufficiency chronic, renal dialysis, water-electrolyte balance, nursing careAbstract
Objetive. To test the effectiveness of nursing intervention to control fluid volume on improving laboratory test results and dialysis adequacy in patients with Excess fluid volume.
Methods. This is a randomized, double-blind, parallel-group controlled trial involving 34 patients with chronic kidney disease and a nursing diagnosis of Excess Fluid Volume undergoing chronic hemodialysis equally randomized into two groups (control n=17 and intervention n=17). Data were collected on sociodemographic and clinical factors, the presence of Excess Fluid Volume, and water balance. Laboratory parameters, including serum electrolytes, urea, creatinine, and dialysis adequacy markers, were assessed before and after the intervention. The intervention consisted of 13 nursing activities, including educational, follow-up, and reminder components, such as fluid balance monitoring, daily weight control, edema assessment, laboratory follow-up, and health education on diet and self-care. The control group received only the usual care provided at the dialysis clinic.
Results. There were significant improvements in laboratory test results and dialysis adequacy. The statistical difference between the groups was significant in the mean values of calcium (p<0.001), post-hemodialysis urea (p=0.002), and creatinine (p=0.006), demonstrating the direct effect of the intervention. In addition, there were improvements in overall dialysis quality and adequacy measures.
Conclusion. The nursing intervention significantly improved laboratory test results and dialysis adequacy in patients with chronic renal failure and Excess Fluid Volume, highlighting its potential for enhancing patient management and nursing care.
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1. Oni OO, Akinwusi PO, Owolabi JI, Odeyemi AO, Israel GM, Ala O, et al. Chronic Kidney Disease and Its Clinical Correlates in a Rural Community in Southwestern Nigeria. Saudi Journal of Kidney Diseases and Transplantation. 2022; 33:774-83.
2. Oliveira REF, Moreno AH. Verification of biochemical, lipid and glycemic parameters in patients undergoing hemodialysis in a teaching hospital in the noroeste paulista. Revista Cuidarte Enfermagem. 2022; 78-85.
3. Sampani E, Theodorakopoulou M, Iatridi F, Sarafidis P. Hyperkalemia in chronic kidney disease: a focus on potassium lowering pharmacotherapy. Expert Opinion on Pharmacotherapy. 2023; 24:1775-89.
4. Moromizato T, Kohagura K, Tokuyama K, Shiohira Y, Toma S, Uehara H, et al. Predictors of Survival in Chronic Hemodialysis Patients: A 10-Year Longitudinal Follow-Up Analysis. American Journal of Nephrology. 2021; 52:108-18.
5. Hu EA, Coresh J, Anderson CAM, Appel LJ, Grams ME, Crews DC, et al. Adherence to Healthy Dietary Patterns and Risk of CKD Progression and All-Cause Mortality: Findings from the CRIC (Chronic Renal Insufficiency Cohort) Study. American Journal of Kidney Diseases. 2021; 77:235-44.
6. Azevedo VNG, Cavalcante TH, Jansen RC, Moreira RP, Lira ALB, Oliveira-Kumakura ARZ. Validation of an instrument to assess fluid control in outpatient hemodialysis patients. Journal of Nursing Education and Practice. 2022; 12:30-7.
7. Beetham KS, Krishnasamy R, Stanton T, Sacre JW, Douglas B, Isbel NM, et al. Effect of a 3-year lifestyle intervention in patients with chronic kidney disease: A randomized clinical trial. Journal of the American Society of Nephrology. 2022; 33:431-41.
8. Voltarelli BC, Ruzzi-Pereira A. Occupational performance of chronic kidney patients undergoing hemodialysis. Revista Família, Ciclos de Vida e Saúde no Contexto Social (REFACS). 2021; 9:631-41.
9. Agrawaal KK, Kandel S, Devkota S. Mean Urea Reduction Ratio among Patients Undergoing Hemodialysis at a Tertiary Care Centre: A Descriptive Cross-sectional Study. Journal of the Nepal Medical Association. 2023; 61:446-50.
10. Herdman TH, Kamitsuru S, Lopes CT. NANDA-I Nursing Diagnoses: Definitions and Classifications (2021-2023). 12th ed. Porto Alegre: Artmed; 2021.
11. Moorhead S, Johnson M, Maas ML, Swanson E. Nursing Outcomes Classification (NOC): Measurement of Health Outcomes. 6th ed. Rio de Janeiro: Elsevier; 2018.
12. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975; 12:189-98.
13. Chidiac C, Chelala D, Nassar D, Beaini C, Azar H, Finianos S, et al. Routine laboratory testing in hemodialysis: how frequently is it needed? BMC Nephrology. 2022; 23:1-9.
14. Felipe C, Natália T, Sheila B. Orientações nutricionais para pacientes com doença renal crônica em hemodiálise. Brasília: Federal District. Multiprofessional Residency in Nephrology - SES DF; 2019.
15. Silva TT, Dantas JKS, Araújo SCM, Silva SO, Dantas DV, Dantas RAN. Strategies for thirst management in postoperative adult patients: a scoping review. Revista Brasileira de Enfermagem. 2022; 75:e20220154.
16. Portales-Castillo I, Rieg T, Khalid SB, Nigwekar SU, Neyra JA. Physiopathology of phosphate disorders. Advances in Kidney Disease and Health. 2023; 30(2):177-88.
17. Yanagawa T, Hirayama A, Osada K, Kuno A, Takahashi S. Sufficient liver erythropoietin synthesis is induced in hemodialysis patients not requiring erythropoiesis-stimulating agents. Clinical Nephrology. 2022; 98:167-70.
18. Koury MJ, Agarwal R, Chertow GM, Eckardt KU, Fishbane S, Ganz T, et al. Erythropoietic effects of vadadustat in patients with anemia associated with chronic kidney disease. American Journal of Hematology. 2022; 97:1178-88.
19. Bialeski AB, Lopes CM, Iser BPM. Factors related to clinical outcomes and survival time in chronic kidney disease patients on hemodialysis. Cadernos de Saúde Coletiva. 2022; 30:115-26.
20. Rehma S, Sharif N, Rahman S. Frequency of vitamin D deficiency and hypocalcemia in patients presented with low back pain in tertiary care hospital Khyber Pakhtunkhwa. Journal of Medical Sciences. 2020; 28:42-5.
21. Zemaitis MR, Foris LA, Katta S, Bashir K. Uremia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
22. Kalim S, Zhao S, Tang M, Rhee EP, Allegretti AS, Nigwekar S, et al. Protein carbamylation and the risk of ESKD in patients with CKD. Journal of the American Society of Nephrology. 2023; 34:876-85.
23. Ko G-J, Rhee CM, Kalantar-Zadeh K, Joshi S. The effects of high-protein diets on kidney health and longevity. Journal of the American Society of Nephrology. 2020; 31:1667-79.
24. Świerczyńska-Mróz K, Nowicka-Suszko D, Fleszar MG, Fortuna P, Krajewski PK, Krajewska M, et al. Serum Level of Protein-Bound Uraemic Toxins in Haemodialysis Patients with Chronic Kidney Disease-Associated Pruritus: Myths and Facts. Journal of Clinical Medicine. 2023; 12:2310.
25. Gaitonde DY, Cook DL, Rivera IM. Chronic kidney disease: detection and evaluation. American Family Physician. 2017; 96:776-83.
26. Brazilian Society of Nephrology. Biomarkers in Nephrology. Accessed 5 June 2023. Available from: https://arquivos.sbn.org.br/pdf/biomarcadores.pdf
27. Raimann JG, Ye X, Kotanko P, Daugirdas JT. Routine Kt/V and normalized protein nitrogen appearance rate determined from conductivity access clearance with infrequent postdialysis serum urea nitrogen measurements. American Journal of Kidney Diseases. 2020; 76:22-31.
28. Masakane I, Ito M, Tanida H, Nawano T. Patient-Centered Care Could Improve Quality of Life and Survival of Dialysis Patients: Dialysis Prescription and Daily Practice. Blood Purification. 2023; 52:44-55.
29. Maduell F, Broseta JJ, Rodríguez-Espinosa D, Del Risco-Zevallos J, Gómez M, Rodas LM, et al. Efficacy and Safety of the Medium Cut-Off Elisio HX Dialyzer. Blood Purification. 2023; 52:68-74.
30. Stumm EMF, Benetti ERR, Pretto CR, Barbosa DA. Effect of educational intervention on the quality of life of hyperphosphathemic chronic renal patients on hemodialysis. Texto & Contexto Enfermagem. 2019; 28:e20180267.
31. Frazão CML, Medeiros ABA, Silva FBBL, Sá JD, Lira ALBC. Nursing diagnoses in chronic renal failure patients on hemodialysis. Acta Paulista de Enfermagem. 2014; 27:40-3.
32. Debone MC, Pedruncci EDSN, Candido MDC, Marques S, Kusumota L. Nursing diagnosis in older adults with chronic kidney disease on hemodialysis. Revista Brasileira de Enfermagem. 2017; 70:800-5.
33. Fernandes MICD, Cavalcanti PKAS, Dantas ALM. Patients receiving hemodialysis with the nursing diagnosis of fluid volume excess: socioeconomic and clinical aspects. Cogitare Enfermagem. 2015; 20:160-8.
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