Reducing Excessive Interdialytic Weight Gain in Young Hemodialysis Patients: A Quality Improvement Initiative

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.

Prospective, single-center, multimodal quality improvement initiative using Plan-Do-Study-Act cycles.

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.

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.

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.

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.

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.

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.

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.