Centre-level fluid management practices in the BISTRO trial and their lack of association with participant fluid status and blood pressure in non-anuric haemodialysis patients
Abstract Introduction Fluid assessment and management is a key aspect of good dialysis care and is affected by patient-level characteristics and potentially centre-level practices. In this secondary analysis of the BISTRO trial we wished to establish whether centre-level practices with the potential...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-11-01
|
| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12882-024-03837-y |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850061981413801984 |
|---|---|
| author | Neena Johal Radha Sharma John Belcher David Coyle Elizabeth J. Lindley David Keane Fergus J. Caskey Indranil Dasgupta Andrew Davenport Ken Farrington Sandip Mitra Paula Ormandy Martin Wilkie Jamie Macdonald Ivonne Solis-Trapala Julius Sim Simon J. Davies |
| author_facet | Neena Johal Radha Sharma John Belcher David Coyle Elizabeth J. Lindley David Keane Fergus J. Caskey Indranil Dasgupta Andrew Davenport Ken Farrington Sandip Mitra Paula Ormandy Martin Wilkie Jamie Macdonald Ivonne Solis-Trapala Julius Sim Simon J. Davies |
| author_sort | Neena Johal |
| collection | DOAJ |
| description | Abstract Introduction Fluid assessment and management is a key aspect of good dialysis care and is affected by patient-level characteristics and potentially centre-level practices. In this secondary analysis of the BISTRO trial we wished to establish whether centre-level practices with the potential to affect fluid status were stable over the course of the trial and explore if they had any residual associations with participant’s fluid status. Methods Two surveys (S) of fluid management practices were conducted in 32 participating centres during the trial, (S1: 2017–18 and S2: 2021–22). Domains interrogated included: dialysate sodium concentration, (D-[Na+]), fluid and salt intake, residual kidney function, use of diuretics, incremental start, approaches to fluid assessment, management and dialysate temperature, (D-oC). Associations of these practices with the closeness of the participant’s post-dialysis target weight to their normally hydrated weight, pre- and post-dialysis systolic (SBP) and diastolic blood pressure, (DBP), were analysed using intra-class correlations and multilevel modelling with adjustment for visit, age, sex and comorbidity burden. Results Variations in centre practices were reported but did not change during the trial, apart from some relaxation in salt and fluid restriction in S2. For our measures of fluid status, measured 2501 times in 439 non-anuric incident haemodialysis patients, centre-level intraclass correlations were extremely low, whereas patient-level correlations ranged between 0.12 and 0.47, strongest for pre- and post-dialysis-SBP, less so for post-dialysis-DBP. Multi-level analysis found no associations between D-[Na+], or assessment methods of fluid status. In S2, one centre, routinely using a D-Co of 35°C had more divergence between the target and normally hydrated weight, but this was not observed in S1, and no other associations were found. Conclusions Centre-level fluid management practices were stable over the course of the BISTRO trial, and in contrast to patient-level factors, no centre-level associations were detected with fluid status or blood pressure. This may be because the trial imposed a standardised approach to fluid assessment in all trial participants who at least initially had residual kidney function, potentially over-riding the effects of other centre practices. Survey responses revealed substantial scope for developing and evaluating standardised protocols to optimise fluid management. |
| format | Article |
| id | doaj-art-a6c32ae259aa424dbff0a4140aeaa363 |
| institution | DOAJ |
| issn | 1471-2369 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj-art-a6c32ae259aa424dbff0a4140aeaa3632025-08-20T02:50:03ZengBMCBMC Nephrology1471-23692024-11-0125111210.1186/s12882-024-03837-yCentre-level fluid management practices in the BISTRO trial and their lack of association with participant fluid status and blood pressure in non-anuric haemodialysis patientsNeena Johal0Radha Sharma1John Belcher2David Coyle3Elizabeth J. Lindley4David Keane5Fergus J. Caskey6Indranil Dasgupta7Andrew Davenport8Ken Farrington9Sandip Mitra10Paula Ormandy11Martin Wilkie12Jamie Macdonald13Ivonne Solis-Trapala14Julius Sim15Simon J. Davies16School of Medicine, Faculty of Medicine and Health Sciences, David Weatherall Building, Keele UniversitySchool of Medicine, Faculty of Medicine and Health Sciences, David Weatherall Building, Keele UniversitySchool of Medicine, Faculty of Medicine and Health Sciences, David Weatherall Building, Keele UniversityNIHR Devices for Dignity, Sheffield Teaching Hospitals NHS Foundation TrustRenal Medicine, Leeds Teaching Hospitals NHS TrustCÚRAM SFI Research Centre for Medical Devices, University of GalwayPopulation Health Sciences, University of BristolRenal Medicine, University Hospitals Birmingham NHS Foundation TrustUCL Department of Renal Medicine, Royal Free Hampstead NHS Trust, University CollegeRenal Medicine, East & North Hertfordshire NHS TrustManchester Academic Health Sciences Centre (MAHSC), University Hospital ManchesterSchool of Health and Society, University of SalfordRenal Medicine, Sheffield Teaching Hospitals NHS Foundation TrustInstitute of Applied Human Physiology, Bangor UniversitySchool of Medicine, Faculty of Medicine and Health Sciences, David Weatherall Building, Keele UniversitySchool of Medicine, Faculty of Medicine and Health Sciences, David Weatherall Building, Keele UniversitySchool of Medicine, Faculty of Medicine and Health Sciences, David Weatherall Building, Keele UniversityAbstract Introduction Fluid assessment and management is a key aspect of good dialysis care and is affected by patient-level characteristics and potentially centre-level practices. In this secondary analysis of the BISTRO trial we wished to establish whether centre-level practices with the potential to affect fluid status were stable over the course of the trial and explore if they had any residual associations with participant’s fluid status. Methods Two surveys (S) of fluid management practices were conducted in 32 participating centres during the trial, (S1: 2017–18 and S2: 2021–22). Domains interrogated included: dialysate sodium concentration, (D-[Na+]), fluid and salt intake, residual kidney function, use of diuretics, incremental start, approaches to fluid assessment, management and dialysate temperature, (D-oC). Associations of these practices with the closeness of the participant’s post-dialysis target weight to their normally hydrated weight, pre- and post-dialysis systolic (SBP) and diastolic blood pressure, (DBP), were analysed using intra-class correlations and multilevel modelling with adjustment for visit, age, sex and comorbidity burden. Results Variations in centre practices were reported but did not change during the trial, apart from some relaxation in salt and fluid restriction in S2. For our measures of fluid status, measured 2501 times in 439 non-anuric incident haemodialysis patients, centre-level intraclass correlations were extremely low, whereas patient-level correlations ranged between 0.12 and 0.47, strongest for pre- and post-dialysis-SBP, less so for post-dialysis-DBP. Multi-level analysis found no associations between D-[Na+], or assessment methods of fluid status. In S2, one centre, routinely using a D-Co of 35°C had more divergence between the target and normally hydrated weight, but this was not observed in S1, and no other associations were found. Conclusions Centre-level fluid management practices were stable over the course of the BISTRO trial, and in contrast to patient-level factors, no centre-level associations were detected with fluid status or blood pressure. This may be because the trial imposed a standardised approach to fluid assessment in all trial participants who at least initially had residual kidney function, potentially over-riding the effects of other centre practices. Survey responses revealed substantial scope for developing and evaluating standardised protocols to optimise fluid management.https://doi.org/10.1186/s12882-024-03837-yBlood pressureBioimpedanceFluid managementHemodialysisComorbidityPractice patterns |
| spellingShingle | Neena Johal Radha Sharma John Belcher David Coyle Elizabeth J. Lindley David Keane Fergus J. Caskey Indranil Dasgupta Andrew Davenport Ken Farrington Sandip Mitra Paula Ormandy Martin Wilkie Jamie Macdonald Ivonne Solis-Trapala Julius Sim Simon J. Davies Centre-level fluid management practices in the BISTRO trial and their lack of association with participant fluid status and blood pressure in non-anuric haemodialysis patients BMC Nephrology Blood pressure Bioimpedance Fluid management Hemodialysis Comorbidity Practice patterns |
| title | Centre-level fluid management practices in the BISTRO trial and their lack of association with participant fluid status and blood pressure in non-anuric haemodialysis patients |
| title_full | Centre-level fluid management practices in the BISTRO trial and their lack of association with participant fluid status and blood pressure in non-anuric haemodialysis patients |
| title_fullStr | Centre-level fluid management practices in the BISTRO trial and their lack of association with participant fluid status and blood pressure in non-anuric haemodialysis patients |
| title_full_unstemmed | Centre-level fluid management practices in the BISTRO trial and their lack of association with participant fluid status and blood pressure in non-anuric haemodialysis patients |
| title_short | Centre-level fluid management practices in the BISTRO trial and their lack of association with participant fluid status and blood pressure in non-anuric haemodialysis patients |
| title_sort | centre level fluid management practices in the bistro trial and their lack of association with participant fluid status and blood pressure in non anuric haemodialysis patients |
| topic | Blood pressure Bioimpedance Fluid management Hemodialysis Comorbidity Practice patterns |
| url | https://doi.org/10.1186/s12882-024-03837-y |
| work_keys_str_mv | AT neenajohal centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT radhasharma centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT johnbelcher centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT davidcoyle centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT elizabethjlindley centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT davidkeane centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT fergusjcaskey centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT indranildasgupta centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT andrewdavenport centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT kenfarrington centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT sandipmitra centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT paulaormandy centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT martinwilkie centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT jamiemacdonald centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT ivonnesolistrapala centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT juliussim centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients AT simonjdavies centrelevelfluidmanagementpracticesinthebistrotrialandtheirlackofassociationwithparticipantfluidstatusandbloodpressureinnonanurichaemodialysispatients |