P106
BIOIMPEDANCE AS A TOOL TO IMPROVE NURSE MANAGEMENT OF BLOOD
PRESSURE IN THE HAEMODIALYSIS SETTING
Crawford, S, Jones, C
Renal Services, York Hospitals Foundation Trust
BACKGROUND:
• The majority of haemodialysis (HD) patients have hypertension and hypertension is
associated with an increased risk of cardiovascular death
• Salt and water retention contribute to increased blood pressure
• We previously reported that the introduction of a nurse led protocol of dry weight
reduction led to improved blood pressure control with less prescription of
antihypertensive medication, but that some patients were unable to tolerate this protocol
because of symptoms and/or hypotension
• The assessment of body composition and extracellular water using bio-electric
impedance may facilitate the management of this group of patients
PURPOSE:
 To incorporate bioimpedance monitoring as an additional management tool in our blood
pressure treatment protocol and to assess its impact on achieved blood pressure,
symptom burden and achievement of ‘dry weight’.
METHODOLOGY:
 All patients with hypertension proven on ambulatory BP monitoring had bioimpedance
assessment using the Fresenius Body Composition Monitor before commencing our
nurse led blood pressure treatment protocol
 Pre-dialysis blood pressure and bioimpedance were repeated regularly during the dry
weight reduction period
 Ambulatory blood pressure was reassessed when patients reached the target zone for
normal hydration as defined for HD patients
 Patients with persistent hypertension despite achieving dry weight were labelled as
having ‘volume’ independent hypertension and managed with medication rather than
being subjected to further inappropriate dry weight reduction
RESULTS:
 We report data on the first 18 patients who completed the nurse led dry weight
reduction protocol
 17 achieved dry weight as defined for HD patients (Over hydration (OH) on
commencement of the protocol averaged 2.1 L , OH on completion averaged 0.6 L)
 BP fell in this group from a mean of 160/90 mmHg to a mean of 148/76 mmHg, despite
reduction in BP medication (average number of antihypertensives in this group on
commencement of the protocol was 1.2 vs. 0.7 on completion)
 At completion 14 had normal blood pressure (<140/85)
 3 remained hypertensive (proven by 24/48 hr ABP monitoring) despite achieving their
target weight (BP on commencement of the protocol averaged 162/84 as compared to
149/86 on completion). They were not subjected to further weight reduction
CONCLUSION:
 Bioimpedance can be used as “another piece of the jigsaw” for accurate assessment of
dry weight in HD patients
 The Fresenius Fluid Management tool provides a graphical, illustrative and user
friendly tool for assessing patients quickly
 Identifying patients with volume-independent hypertension avoids unnecessary dry
weight reduction and allows appropriate prescription of antihypertensive medication