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The following is a summary of “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,” published in the November 2024 issue of Nephrology by Johal et al.
Fluid assessment in dialysis is influenced by patient and center-level factors. This analysis explored center-level fluid practices and their impact on fluid status in the BISTRO trial.
Researchers conducted a retrospective study to analyze center-level practices affecting fluid status in the BISTRO trial and their stability over time.
In 32 centers, 2 surveys (S) of fluid management practices were conducted (S1: 2017–18, S2: 2021–22). Practices assessed included dialysate sodium concentration (D-[Na+]), fluid intake, residual kidney function, diuretics, and dialysate temperature (D-oC). Associations with target weight and blood pressure pre- and post-dialysis systolic (SBP) and diastolic blood pressure (DBP) were analyzed using multilevel modeling, adjusting for visit, age, sex, and comorbidity.
The results showed variations in center practices, with no significant changes except some relaxation in salt and fluid restriction in S2. Fluid status, measured 2,501 times in 439 non-anuric hemodialysis patients, showed low center-level intraclass correlations and patient-level correlations ranging from 0.12 to 0.47. Multi-level analysis found no associations between D-[Na+], fluid status assessments, or fluid management. In S2, 1 center using a D-Co of 35°C showed more divergence in target and normally hydrated weight, but no similar results were seen in S1.
The study concluded that center-level fluid management practices did not affect fluid status or blood pressure, likely due to the trial’s standardized approach. There was potential for developing standardized protocols to optimize fluid management.
Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03837-y
