Subclinical volume overload was common in hemodialysis patients following hospital discharge, but objective measuring tools could be the key to early detection, according to a new quality improvement study.
Out of 62 unique patients across 91 hospitalization events, 22% of discharges required at least one additional hemodialysis session shortly after leaving the hospital, found Leora Wanounou, NP, of St. Michael’s Hospital of Unity Health Toronto.
Patients requiring these extra sessions showed significantly greater inpatient weight gain compared to those who did not (+1.87 kg vs +0.04 kg, P=0.03). This suggests that fluid accumulation during a hospital stay may predict post-discharge instability, Wanounou reported at the National Kidney Foundation Spring Clinical Meeting.
Gaining weight is “not what you would expect while they’re admitted to the hospital,” she noted. “They were probably getting fluids for infections, volume resuscitation, etc., but that weight was not taken off while they were inpatient getting hemodialysis.”
“We know that half of hemodialysis patients have volume overload, and that the post-hospital discharge period is this high-risk transition period where you have to really assess them, and find out what their target weight is now, and whether or not it’s changed,” Wanounou continued. Historically, most assessments have relied on subjective markers, such as physical exams and patient-reported symptoms.
“If we were to have more of a structured volume assessment before these people leave the hospital, we can improve the detection of fluid overload, reduce the need for additional dialysis sessions, and enhance patient outcomes,” she said.
Wanounou and colleagues moved away from subjective measures and utilized two objective tools: body impedance spectroscopy (BIS), which measures intracellular and extracellular fluid volumes, and point-of-care ultrasound (POCUS) of the lungs to detect B-lines, a marker of pulmonary congestion.
Of the 39 patients who received an ultrasound, 59% had B-lines consistent with pulmonary congestion. Among those who required additional dialysis after discharge, that number jumped to 78%. Meanwhile, among the 59 patients who underwent spectroscopy, the average post-discharge over-hydration was 2.36 L.
These tools detect “clinically silent fluid overload,” Wanounou noted, as many patients showed objective evidence of pulmonary congestion despite appearing clinically stable.
Wanounou said the goal is to use the tools to see if patients are still volume-expanded while they’re admitted and determine if they need an extra dialysis session in the hospital before they’re discharged, as opposed to discharging them and making them come back.
The findings support a “volume first” approach to post-discharge care. Wanounou emphasized that incorporating structured assessment protocols could improve detection, reduce the burden of extra treatments, and ultimately boost patient outcomes.
POCUS and/or BIS was performed based on patient and provider preferences within 1 week of discharge. While their use was inconsistent — suggesting variation in workflow and practice — the tools were able to provide complementary and actionable insights into systemic and pulmonary fluid status when applied, noted Wanounou.
The 6-month quality improvement study ran from January to July 2024 at St. Michael’s Hospital and Kidney Care Clinic hemodialysis units in Toronto. Patient weight during hospitalization, target weight, and length of stay were collected. Reasons for hospitalization were most commonly due to infections/inflammatory, cardiovascular, or psychiatric/neurological reasons.
After returning to their home hemodialysis unit, the researchers recorded dates of any additional sessions.
Source link : https://www.medpagetoday.com/meetingcoverage/nkf/121195
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Publish date : 2026-05-10 20:32:00
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