Authors (including presenting author) :
Lee P(1), Leung J(1), Wong MY(1), Ho E(1), Kwok MK(1), Yeung S(1), Tsang S(1)
Affiliation :
(1)Haemodialysis Centre, Department of Medicine, Tseung Kwan O Hospital
Introduction :
Haemodialysis (HD) is a mode of kidney replacement therapy. An adequate and effective dialysis can reduce uremic complications and improve patient’s quality of life. Therefore, Body Composition Machine (BCM) is employed to provide information on urea distribution volume and total body water (TBW) for determination of dialysis dose for HD patients in TKOH since November 2018.
Objectives :
To enhance an optimal body fluid status and improve patient’s wellbeing through utilization of bio-impedance technology.
Methodology :
All hospital HD patients were recruited for TBW measurement using the BCM since November 2018. Findings were recorded and analysed by a pre-set formula. Baseline dialysis adequacy (Kt/V) data was calculated through blood test. Presence of uremic symptoms and fluid status were explored prior BCM measurement by nurses. Dialysis dose prescription including type of dialyzer, desired body weight, blood flow rate, duration and frequency of HD were adjusted according to Kt/V and BCM result. Renal nurses were empowered to provide fine adjustment on the total fluid removal during dialysis. In addition, diet and fluid education were provided by nurses to patients with dialysis compliance problems proactively. Finally, follow-up Kt/V measurement (on-line) and frequency of dialysis complications were collected after two-month for evaluation.
Result & Outcome :
From 1st Nov 2018 to 28th Feb 2019, 20 HD patients had conducted the BCM measurement with standard Kt/V calculation. Female to male ratio was 11:9. Median age was 66 year-old (range, 22 - 78). According to baseline BCM, 19 patients (95%) presented with over-hydration 0.9 – 3.6L. Most patients (85%) had symptoms of fluid overload or with inter-dialysis weight gain ≥ 3 kg. Besides, 14 (70%) patients reported to have intra-dialytic complications such as muscle cramps and hypotension during HD.
Consequently, 5 patients (25%) had adjustment on desired body weight. 2 patients extended the dialysis duration and 1 patient increased dialysis frequency. 2 patients changed to other dialyzer and 1 with access intervention. On follow-up measurement, 17 patients (85%) demonstrated dialysis adequacy with desirable Kt/V. Patients with fluid overload symptoms and intra-dialytic complications were reduced to 60% and 45% respectively.
Use of BCM is cost effective in accordance with calculation of Kt/V provides information for correction of volume input to HD patients. Technological measure on fluid management was able to provide optimal dialysis outcome and enhance patient’s quality of life.
