Predictors of excess fluid volume in hemodialysis patients: an observational study

Fernandes, Maria Isabel da Conceição Dias; Tinôco, Jéssica Dantas de Sá; Fernandes, Renata Marinho; Silva, Juliana Barbosa da; Almeida, Anna Thays Dias; Frazão, Cecília Maria Farias de Queiroz; Lopes, Marcos Venícius de Oliveira; Lira, Ana Luisa Brandão de Carvalho

doi:10.1590/0034-7167-2022-0816

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 77 (1) • 2024 • https://doi.org/10.1590/0034-7167-2022-0816 copy

Predictors of excess fluid volume in hemodialysis patients: an observational study

Preditores de volume excessivo de líquidos em pacientes em hemodiálise: estudo observacional

Predictores de volumen excesivo de líquidos en pacientes en hemodiálisis: estudio observacional

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to assess risk factors for excess fluid volume in hemodialysis patients.

Methods:

a retrospective case-control study was conducted. A total of 392 patients (196 cases and 196 controls) from two hemodialysis centers were included. Sociodemographic data and 23 risk factors for excess fluid volume were assessed using a data collection form. Data were analyzed using a multivariate logistic regression model.

Results:

the insufficient knowledge (OR=2.06), excessive fluid intake (OR=2.33), inadequate fluid removal during hemodialysis (OR=2.62) and excessive sodium intake (OR=1.91) risk factors may increase the chance of occurrence of excess fluid volume in hemodialysis patients by approximately two times. Education level (OR=0.95) and age (OR=0.97) are protective factors for excessive fluid volume.

Conclusions:

knowing these risk factors may help nurses with accurate and rapid diagnostic inference of the risk of excessive fluid volume.

Descriptors:
Nursing; Edema; Renal Dialysis; Risk Factors; Observational Study

Variables			Groups					Total			OR 95%CI		X¹ 1 Kolmogorov-Smirnov test;	p value² 2 Fisher-Freeman-Halton test; MR = mean ranks.
			Case (n = 196)		Control (n = 196)			Total
			n	%	n		%	n		%
Gender
Female			101	51.5	87		44.4	188		48.0	1.33		2.00	0.157
Male			95	48.5	109		55.6	204		52.0	0.89-1.98
Ethnicity
Brown			104	53.1	103		52.6	207		52.8
White			53	27.0	67		34.2	120		30.6	--		4.24	0.120
Black			39	19.9	26		13.3	65		16.6	--
Religion
Yes			118	60.2	118		60.2	236		60.2	1,00		0.00	1.000
No			78	39.8	78		39.8	156		39.8	0.67-1.50
Variables	Groups	Minimum/Maximum		Median	IQR	K-S test¹ 1 Kolmogorov-Smirnov test;					Mann-Whitney test
Variables	Groups	Minimum/Maximum		Median	IQR	D		Df	p value		MR	U		p value
Age (years)	Case	20/86		51.0	22	0.073		196	0.014		177.5	15488.5		0.001
Age (years)	Control	18/89		56.0	21	0.051		196	0.200		215.5
Education level	Case	0/20		8.5	08	0.143		196	<0.001		186.8	17312.5		0.088
Education level	Control	0/23		10.0	08	0.149		196	<0.001		206.2
Family income	Case	0/20		2.0	02	0.278		196	<0.001		181.7	16305.0		0.007
Family income	Control	0/60		2.0	03	0.310		196	<0.001		211.3

Risk factors	Case		Control		Total		Odds Ratio 95%CI	X²2 Canaud B, Morena-Carrere M, Leray-Moragues H, Cristol JP. Fluid overload and tissue sodium accumulation as main drivers of protein energy malnutrition in dialysis patients. Nutrients. 2022;14(4489):1-14. https://doi.org/10.3390/nu14214489 https://doi.org/10.3390/nu14214489...	p value¹ 1 Fisher’s Exact test.
Risk factors	n	%	n	%	Total		Odds Ratio 95%CI		p value¹ 1 Fisher’s Exact test.
Increased dialysate sodium concentration	00	0.0	02	1.0	02	1.0	--	--	0.499
Absence in the hemodialysis session	18	9.2	22	11.2	40	10.2	0.80 0.41-1.54	0.44	0.505
Insufficient water assessment	133	67.9	144	73.5	277	70.7	0.76 0.49-1.18	1.49	0.222
Low self-efficacy for fluid restriction	08	4.1	07	3.6	15	3.8	1.15 0.41-3.23	0.07	0.792
Comorbidities	118	60.2	126	64.3	244	62.2	0.84 0.56-1.26	0.69	0.405
Insufficient knowledge	52	26.5	38	19.4	90	23.0	1.50 0.93-2.41	2.83	0.093
Decline in renal function	196	100	196	100	392	100	--	--	--
Decreased urine volume	147	75.0	137	69.9	284	72.4	1.29 0.83-2.01	1.28	0.258
Inflammatory state	11	5.6	11	5.6	22	5.6	0.99 0.38-2.60	0.00	1.000
Hospital admission	12	6.1	18	9.2	30	7.7	0.64 0.30-1.38	1.30	0.254
Age ≥ 60 years	54	27.6	83	42.3	137	34.9	0.52 0.34-0.79	9.44	0.002
Altered Body Mass Index	102	52.0	111	56.6	213	54.3	0.83 0.56-1.24	0.83	0.361
Excessive fluid intake	114	58.2	72	36.7	186	47.4	2.39 1.59-3.59	18.04	<0.001
Excessive protein intake	167	85.2	157	80.1	324	82.7	1.43 0.84-2.42	1.78	0.182
Excessive sodium intake	176	89.8	161	82.1	337	86.0	1.91 1.06-3.45	4.76	0.029
Low Kt/V index	28	14.3	32	16.3	60	15.3	0.85 0.49-1.48	0.31	0.575
Low serum albumin level	--	--	--	--	--	--	--	--	--
High serum phosphorus level	88	44.9	77	39.3	165	42.1	1.26 0.84-1.88	1.27	0.260
Decreased serum lymphocyte level	57	29.1	64	32.7	121	30.9	0.85 0.55-1.30	0.59	0.444
Inadequate fluid removal during hemodialysis	133	67.9	91	46.4	224	57.1	2.44 1.61-3.67	18.37	<0.001
Thirst	187	95.4	189	96.4	376	95.9	0.77 0.28-2.11	0.26	0.610
Use of antihypertensive drugs	31	15.8	19	9.7	50	12.8	1.75 0.95-3.22	3.30	0.069
Xerostomia	184	93.9	180	91.8	364	92.9	1.36 0.63-2.96	0.61	0.433

Variables	Coef.	S.E.	X²2 Canaud B, Morena-Carrere M, Leray-Moragues H, Cristol JP. Fluid overload and tissue sodium accumulation as main drivers of protein energy malnutrition in dialysis patients. Nutrients. 2022;14(4489):1-14. https://doi.org/10.3390/nu14214489 https://doi.org/10.3390/nu14214489...	df	Sig.	OR	95%CI
Insufficient knowledge	0.72	0.29	6.33	1	0.012	2.06	1.17	3.61
Excessive fluid intake	0.85	0.22	14.29	1	<0.001	2.33	1.50	3.61
Inadequate fluid removal during hemodialysis	0.96	0.22	18.71	1	<0.001	2.62	1.69	4.06
Education level	-0.05	0.02	4.68	1	0.031	0.95	0.91	0.99
Age	-0.03	0.01	13.81	1	<0.001	0.97	0.96	0.98
Constant	0.84	0.51	2.70	1	0.100	2.33
Adjustment measures				df	Sig.
Hosmer-Lemeshow test			10.28	8	0.246
Omnibus test			58.53	5	<0.001
Nagelkerke’s R²			0.185

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Maria Isabel da Conceição Dias Fernandes, E-mail: isabel.dias@ufrn.br