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Overhydration is a known risk factor for morbidity and mortality in patients on Chronic Hemodialysis (HD), specially associated with an increased risk of cardiovascular events.
Design: An open intervention study with a single branch, executed by a multidisciplinary team (MDT) (Nephrologist, Psychologist, Social Worker and Nutritionist), consisting of 4 weekly semi-structured remote interviews. The weekly interviews included: 1) Importance of Fluid as a risk factor and its Management, 2) Diet and strategies to control water and salt intake, 3) social factors and family participation in water and salt intake, 4) commitment for Fluid intake control. The impact of the intervention was evaluated by comparing blood pressure (BP), interdialytic weight gains (IWG), and average overweight of the month before and after the intervention. Patients’ satisfaction with the intervention was measured by a blind interview. Delta dry weight (ΔDW) was considered as mean post-dialysis weight minus dry weight.
Inclusion criteria: patients on HD > 3 months, with OH>5 of dry weight in the month before the study.
Exclusion criteria: moderate to severe cognitive impairment, severe hearing impairment, or hospitalized.
Data Analysis: Quantitative data was expressed as mean and Standard deviation (SD) and qualitative data as percentage. Pre and post intervention was compared by Student T test for paired data or Mc Nemar chi square Test.
Twenty-nine were included, 16 men (55.2%), 16 diabetics (55.2%), mean age of 69.0 ± 11.2 years, dialysis vintage of 51.2 ± 39.2 months.
The average overweight was significantly reduced from 4.65 ± 1.39 % to 4.19 ± 1.37% (p= 0.016). IWG was diminished from 3.75 ± 0.95 Kg to 3.42 ± 0.73 Kg (p= 0.055). ΔDW reduced from 1.30 ± 1.38 to 1.05 ± 1.30 (P: NS). Systolic (SBP) and diastolic blood pressure (DBP) did not show significant variations (SBP 120.1 ± 19.6 mmHg vs 113.7 ±16.8 and DBP 66.2 ± 8.9 mmHg vs 64.7 ± 16.8).
The satisfaction survey was carried out on 25 of 29 patients, the information provided and the strategies to reduce liquid consumption were evaluated satisfactorily in all of them.
This pilot study to evaluate a remote strategy of Telemedicine Support to reduce overhydration can be considered as an effective strategy and well evaluated by the HD patients. We consider that a bigger study with the participation of a greater number of patients is required to have more certainty of the results. It would also be desirable to include a further in time evaluation, to quantify if the benefits of the strategy are long time sustained.