Fluid Management Quality Improvement Project Using Relative Blood Volume Monitoring

San Diego—Patients receiving hemodialysis at 20 Renal Research Institute clinics participated in a 1-year fluid management quality improvement (QI) project utilizing relative blood volume monitoring (RBV-M). Paul Balter, MD, and colleagues conducted a retrospective database analysis to examine changes in body weight and blood pressure in the participating patients. Results of the analysis were reported during a poster session at Kidney Week 2018 in a poster titled Reduction in Mean Patient Body Weight and Blood Pressures Were Observed during a Fluids Management Quality Improvement (QI) Project Utilizing Relative Blood Volume Monitoring (RBV-M).

Eligible patients received hemodialysis in the month prior to the QI project (pre-QI) and in the month at the end of the project. RVB-M was used to monitor relative blood volume during hemodialysis with Crit-Line® Monitors (CLM-III, CLM-IV, or CLiC). For each patient, all available pre-hemodialysis and post-hemodialysis body weights and systolic and diastolic blood pressures were averaged monthly. The researchers conducted a subgroup analysis of patients with pre-QI hypertension; patients with pre-hemodialysis systolic blood pressure of ≥140 mmHg and/or pre-hemodialysis diastolic blood pressure of ≥90 mmHg during the pre-QI period were included in the subanalysis. Paired t-tests were used to test for differences between pre-QI and QI month 12.

A total of 651 patients were included in the analysis; of those, 473 had pre-QI hypertension.

From pre-QI to QI month 12, mean pre-hemodialysis weight decreased from 84.06 kg to 83.27 kg (–0.79 kg, P<.0001) and post-hemodialysis weight decreased from 81.71 kg to 80.96 kg (–0.75; P<.0). Mean pre-hemodialysis systolic blood pressure decreased from 152.04 mmHg to 149.92 mmHg (–2.12 mmHg, P=.005) and mean post-hemodialysis systolic blood pressure decreased from 139.32 mmHg to 137.09 mmHg (–2.23 mmHg, P=.003). During the study period, mean pre-hemodialysis diastolic blood pressure decreased from 80.07 mmHg to 78.70 mmHg (–1.37 mmHg, P=.002) and post-hemodialysis diastolic blood pressure decreased from 73.69 mmHg to 72.41 mmHg (–1.28 mmHg; P=.001).

In the subgroup analysis of patients with hypertension during the pre-QI period, on average pre-hemodialysis systolic blood pressure decreased from 161.54 mmHg to 156.55 mmHg (–4.99 mmHg; P<.0001) and post-hemodialysis systolic blood pressure decreased from 145.56 mmHg to 141.56 mmHg (–4.00 mmHg; P<.0001).

In conclusion, the researchers said, “A QI project on fluid management utilizing RBV-M was associated with reductions in patient body weights and blood pressures. Most patients had pre-QI hypertension (73%). These patients had an average decrease in pre-hemodialysis systolic blood pressure of 4.99 mmHg and may be a population that could particularly benefit from a QI initiative on fluid management.”

Source: Balter P, Li Y, Mullon C, Kossmann RJ, Ficociello L. Reduction in mean patient body weights and blood pressures were observed during a fluid management quality improvement (QI) project utilizing relative blood volume monitoring (RBV-M). Abstract of a poster (FR-PO747) presented at the American Society of Nephrology Kidney Week 2018, October 26, 2018, San Diego, California.

Funding for this analysis was provided by Fresenius Medical Care Renal Therapies Group.