Best Evidence Summary for Volume Management of Patients With Heart and Kidney Comorbidity.
Huang Aoli, Chen Xia, Zhu Xujing and 3 others
PMID 42186083WHAT IT FOUND
Nurses caring for patients with both heart and kidney disease should monitor weight, intake, output and blood pressure, escalate sudden weight gain above 2 kg in 3 days, and use dynamic volume assessment with symptoms, labs and imaging.
Key findings
01Volume status should be assessed dynamically using symptoms, signs, laboratory indicators and imaging such as BNP, NT-proBNP, carbohydrate antigen 125, chest X-ray and cardiovascular ultrasound.
02Bioimpedance-guided volume management was associated with reduced all-cause mortality, decreased overhydration, improved blood pressure and increased cost-effectiveness among dialysis patients.
03Targeted education on home monitoring, symptom recognition and salt or fluid restriction improved dry weight and volume self-management in randomised trials.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is an evidence summary, not a new trial, so it cannot show that any single strategy improves outcomes in every patient. Only English and Chinese literature was searched, and unpublished studies were not included, so relevant evidence may be missing. Six included randomised trials had unclear allocation concealment or blinding, which can affect subjective outcomes. Guidelines and expert consensus made up much of the evidence, and several did not describe how they gathered evidence or disclose competing interests. No unified intake and output limits were available for patients with heart and kidney comorbidity.
Declared interests
The authors report nothing to report for funding and declare no conflicts of interest.
The easy way to misread this
Do not read these 37 items as a single tested treatment protocol. Many come from guidelines, expert consensus or small studies, and the randomised trials had unclear allocation concealment or blinding.