UK National Survey of Practice Patterns of Fluid Volume Management in Haemodialysis Patients: A Need for Evidence

Abstract

Background: Fluid management in haemodialysis (HD) affects patient experience, morbidity and mortality. Standards for best practice are lacking. A national survey of the United Kingdom was undertaken to define prevalent practice. Methods: An online questionnaire was distributed to all UK renal centres. Results: Forty-five of 74 centres (173 dialysis units), serving 62% (n = 14,697) of UK HD population responded. Seventy-eight per cent had no agreed policy for managing fluid balance in patients on HD; 44% did not assess fluid status routinely. Clinical assessment was the norm; 27% used bio-impedance-based device. To achieve a target-weight, 53% reduced weight as far as tolerated. Twenty-two per cent measured residual renal function (RRF). Ninety-one per cent had no policy for fluid overload. Sixty-four per cent restricted salt and water. Ninety-three per cent used diuretics in patients with RRF. Thirty-eight per cent felt management was adequate; 77% felt there was a need for better evidence. Ninety-one per cent would participate in a study addressing this. Conclusion: There is an urgent need for establishing an evidence base on the optimal approaches to fluid management.