Feasibility and acceptability of weight-based net fluid removal during continuous kidney replacement therapy: A...

Among critically ill patients with acute kidney injury, observational studies show that weight-based net fluid removal (i.e., net ultrafiltration, UF_NET) during continuous kidney replacement therapy (CKRT) is associated with mortality. However, the feasibility and clinician acceptability of a weight-based UF_NET strategy are unclear.

In a survey study, we evaluated nurses' perceptions and attitudes toward the weight-based UF_NET strategy supported by an automated fluid removal calculator during CKRT. We surveyed ICU nurses caring for patients enrolled in the Restrictive versus Liberal Rate of Extracorporeal Volume Removal Evaluation in Acute Kidney Injury (RELIEVE-AKI) trial at the University of Pittsburgh Medical Center and the Mayo Clinic ICUs.

Of the 90 nurses who participated, 59% agreed that weight-based UF_NET reduced the risk of fluid overload, and 50% believed it reduced intradialytic hypotension; only 41% felt that the method allowed flexibility in fluid removal. Increased nursing workload (36%) and time demands (24%) were frequently cited barriers. Regarding the automated calculator, 70% of nurses agreed it was easy to learn, and 47% found it clinically valuable. However, 31% reported an increased workload, and 37% noted that it added time to their workflow. Nurses emphasized the importance of individualizing fluid removal decisions based on patient-specific factors, beyond body weight.

The successful implementation of weight-based UF_NET strategy and automated decision support requires robust training, workflow integration, and support for clinical judgment, underscoring the importance of striking a balance between protocol-driven care and real-world usability, as well as incorporating provider input.

Implementing weight-based ultrafiltration by net fluid removal (UF_NET) and an automated calculator in clinical practice presents both opportunities and challenges. Weight-based ultrafiltration and automated calculators can reduce fluid overload and hypotension but raise concerns about nursing workload, time, and flexibility. Individualized fluid management remains crucial, emphasizing the need to strike a balance between standardization and patient-specific needs.