The Dry-Weight Dilemma: Survey Results Based on a Qualitative Interview Study on Fluid Overload in Hemodialysis

Chronic fluid overload (FO) can be detected using bioimpedance spectroscopy (BIS) and is associated with higher mortality risk than interdialytic weight gain in patients receiving hemodialysis (HD). This study aimed to explore patients' perspectives and comprehension of FO and dry weight.

Qualitative study arm of an exploratory, nonrandomized observational study.

Semistructured interviews were conducted in 25 HD patients at Vienna General Hospital. A survey was developed based on the interview data and distributed across 3 HD centers (n = 148).

A mixed-methods approach was applied: grounded theory guided qualitative coding, whereas survey data were analyzed descriptively.

11 of 25 interviewed patients had chronic FO > 15% BIS-defined extracellular volume predialysis. Theme 1, "Being aware of fluid restrictions," contained the following subthemes: (1a) "Restrictive fluid intake is the major burden," (1b) "Symptom awareness of FO," (1c) "Misconception of chronic FO," (1d) "Unawareness of BIS," and (1e) "neglected salt restriction." Subthemes 1c and 1d were reinforced by the survey, in which 54.7% fully or partially agreed that chronic FO occurs between HD sessions (misunderstood as interdialytic weight gain). Theme 2, "Dry weight is a feel-good factor," contained subthemes, (2a) "Inconclusive definitions of dry weight," (2b) "Better too high than too low," (2c) "Self-management of dry-weight prescription," and (2d) "Uncertainties in weight documentation." In our survey, 77.9% reported being able to define dry weight; 64.2% fully or partially agreed they currently had the correct dry weight; and 65.0% did not feel overhydrated (chronic FO was prevalent in ∼40%). 64.5% were not interested in participating in an educational event on dry weight and chronic FO.

Sample size, gender bias, and the survey was not validated externally.

Substantial knowledge gaps existed regarding dry weight and chronic FO, necessitating improved patient engagement strategies into fluid management and further research into the underlying reasons for patients' disinterest.