Thinking Volume First: Developing a Multifaceted Systematic Approach to Volume Management in Hemodialysis

Area of Science:

• Nephrology
• Internal Medicine
• Clinical Management

Background:

• Volume overload and hypovolemia are prevalent issues in hemodialysis (HD) patients, often leading to hospitalizations.
• A structured approach to managing volume status can improve patient outcomes and experience.

Purpose of the Study:

• To develop and implement a novel strategy for systematically addressing volume issues in hemodialysis patients.
• To leverage electronic medical records, technology, and multidisciplinary expertise for improved volume management.

Main Methods:

• Implemented a multidisciplinary volume management program in an urban academic hospital's HD unit.
• Generated volume metrics from electronic medical records and conducted root cause analysis.
• Developed pragmatic interventions targeting identified causes of abnormal volume metrics.

Main Results:

• Integrated volume metric reporting into routine bloodwork for enhanced patient surveillance.
• Utilized technological adjuncts like lung ultrasound and bioimpedance spectroscopy for advanced volume assessment.
• Instituted interdisciplinary reviews for nutritional and social interventions in patients with abnormal volume metrics.

Conclusions:

• Successfully implemented a local volume management program in a single HD center.
• Further outcome assessment and multi-center feasibility studies are required before widespread adoption.
• The long-term benefits and sustainability of this program require additional investigation.