实施护士主导的容积和血压优化-使用技术(新颖性)在慢性肾脏疾病的多层次启用:一项前瞻性队列研究。

IF 1.8 4区 医学 Q2 UROLOGY & NEPHROLOGY
Nephron Pub Date : 2025-01-01 Epub Date: 2025-02-03 DOI:10.1159/000543948
Zhihua Huang, Li Choo Ng, Irene Mok, Chieh Suai Tan, Cynthia Ciwei Lim
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引用次数: 0

摘要

背景:体液超载是慢性肾脏疾病(CKD)的常见表现,与住院和死亡增加有关。然而,严重的症状性体液超载是有可能预防的,只要及早发现轻度体液超载,及时采取适当的药物治疗和限制体液。我们实施并评估了一个护士主导的诊所的结果,该诊所将使用身体阻抗分析(BIA)的客观液体容量评估纳入到对CKD和液体超载患者的结构化患者教育和行动计划指导中。方法:对2022年8月至2024年4月期间参与该计划的成年人进行单中心前瞻性实施前后研究(表1)。如果患者患有不需要透析的CKD,并且有液体超载和/或收缩压(BP) >60 mmHg或舒张压>00 mmHg,则符合条件。临床效果的结果是液体超载的症状和体征以及血压的改善。患者报告的有效性结果是使用健康伙伴(PIH)问卷评估慢性疾病自我管理,以及通过EuroQOL-5维度(EQ5D5L)调查评估健康相关生活质量(HrQOL)。临床安全结果为低血压和肾功能恶化。结果:107例患者中,96例参加了第一次就诊。中位年龄为68.5 (IQR为60.2,77.3)岁,eGFR为21.6 (14.0,39.7)ml/min/1.73 m2。几乎所有参与者(93.8%)在第一次复查前1个月内都有体液超载症状。52例(54.2%)患者行BIA,中位过水合为2.4(1.3,3.6)升。第二次和第三次就诊分别有38例(39.6%)和28例(29.2%)患者。在项目完成时,患者的症状和体征均有所减轻,收缩压[137(121,143)对151 (132,166)mmHg, p=0.03]和自我管理[PIH评分96(89,104)对72 (57,88),p=0.001]较基线就诊有所改善。EQ5D5L评分差异有统计学意义。结论:一个由护士主导的项目,包括客观的液体容量评估、结构化的患者教育和CKD和液体超载患者的行动计划指导,可改善血压和自我管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Implementing the Nurse-Led Optimization of Volume and Blood Pressure - Enabling at Multi-Levels Using Technology Program for Chronic Kidney Disease: A Prospective Cohort Study.

Implementing the Nurse-Led Optimization of Volume and Blood Pressure - Enabling at Multi-Levels Using Technology Program for Chronic Kidney Disease: A Prospective Cohort Study.

Background: Fluid overload is a common manifestation of chronic kidney disease (CKD) and is associated with increased hospitalizations and death. However, severe symptomatic fluid overload is potentially preventable with early recognition of mild fluid overload and timely institution of appropriate pharmacotherapy and fluid restriction. We implemented and evaluated the outcomes of a nurse-led clinic that incorporated objective fluid volume assessment using body impedance analysis (BIA) into structured patient education and action plan coaching to patients with CKD and fluid overload.

Methods: This was a single-center prospective pre-post-implementation study of adults who participated in the program between August 2022 and April 2024. Patients were eligible if they had CKD not requiring dialysis and had fluid overload and/or systolic blood pressure (BP) >160 mm Hg or diastolic BP >100 mm Hg. The clinical effectiveness outcomes were symptoms and signs of fluid overload and improvement in BP. The patient-reported effectiveness outcomes were chronic disease self-management assessed using the Partner in Health (PIH) questionnaire and health-related quality of life assessed by the EuroQOL-5 Dimension (EQ5D5L) survey. The clinical safety outcomes were (1) hypotension with systolic BP <90 mm Hg and (2) worsening kidney function.

Results: Among 107 patients referred to the nurse-led program, 96 attended the first visit. Median age was 68.5 (IQR 60.2, 77.3) years, and eGFR was 21.6 (14.0, 39.7) mL/min/1.73 m2. Almost all participants (93.8%) had symptoms of fluid overload within the past 1 month before the first review. BIA was performed for 52 (54.2%) patients, and the median overhydration was 2.4 (1.3, 3.6) L. The second and third visits were attended by 38 (39.6%) and 28 (29.2%) patients, respectively. For these 28 patients at program completion, symptoms and signs of fluid overload were less frequent and systolic BP (137 [121, 143] vs. 151 [132, 166] mm Hg, p = 0.03) and self-management (PIH score 96 [89, 104] vs. 72 [57, 88], p = 0.001) had improved compared to their baseline visit. EQ5D5L scores were significantly different. None experienced hypotension (systolic BP <90 mm Hg), and kidney function did not change significantly during follow-up.

Conclusion: A nurse-led program that incorporated objective fluid volume assessment, structured patient education, and action plan coaching for patients with CKD and fluid overload improved the BP and self-management of those who completed the program.

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来源期刊
Nephron
Nephron UROLOGY & NEPHROLOGY-
CiteScore
5.00
自引率
0.00%
发文量
80
期刊介绍: ''Nephron'' comprises three sections, which are each under the editorship of internationally recognized leaders and served by specialized Associate Editors. Apart from high-quality original research, ''Nephron'' publishes invited reviews/minireviews on up-to-date topics. Papers undergo an innovative and transparent peer review process encompassing a Presentation Report which assesses and summarizes the presentation of the paper in an unbiased and standardized way.
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