Effect of the fluid management nursing intervention on improving biochemical test results and dialysis therapy in chronic kidney disease patients: a randomized controlled trial.
José Erivelton de Souza Maciel Ferreira, Daniel Freire de Sousa, Rafaella Pessoa Moreira and 3 others
PMID 41289536WHAT IT FOUND
In 34 hemodialysis patients, adding a one-month nursing fluid-volume protocol did not produce a significant between-group difference in Kt/V.
URR fell more in control than intervention, but baseline hematocrit and hemoglobin differed.
Key findings
01The groups were not balanced at baseline for hematocrit (control 43.3±4.1, intervention 37.1±5.0; p<0.001) or hemoglobin (control 13.2±1.3, intervention 11.6±1.6; p=0.002).
02Post-intervention Kt/V was 1.6±0.3 in the intervention group and 1.4±0.5 in the control group, and the between-group comparison approached significance (p=0.056).
03URR decreased from 73.3±7.4 to 69.7±12.9 (p=0.001), with the most pronounced reduction observed in control compared with intervention (p=0.003).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included 34 patients from one dialysis center and used a convenience sample without a formal sample size calculation, so it is small and may not represent all hemodialysis patients. Baseline hematocrit and hemoglobin differed significantly between groups (hematocrit p<0.001; hemoglobin p=0.002), which makes group comparisons less clean. Participants knew their allocation because the intervention was visible, although laboratory outcome assessors and the statistician were blinded. The intervention lasted only one month, and the outcomes were biochemical tests and dialysis adequacy measures. GFR could not be calculated, and non-routine tests such as serum glucose were not analyzed because not all patients had them. Carvedilol use differed between groups (one in control, eight in intervention; p=0.017), although the paper states it did not influence outcomes.
The easy way to misread this
Do not conclude that fluid control alone improved dialysis adequacy. The post-intervention Kt/V difference was not significant (p=0.056), the groups differed at baseline for hematocrit (p<0.001) and hemoglobin (p=0.002), and the protocol was delivered alongside routine dialysis care and 13 bundled activities.