Perspectives on clinical use of bioimpedance in hemodialysis: focus group interviews with renal care professionals

Abstract

BackgroundInadequate volume control may be a main contributor to poor survival and high mortality in hemodialysis patients. Bioimpedance measurement has the potential to improve fluid management, but several dialysis centers lack an agreed fluid management policy, and the method has not yet been implemented. Our aim was to identify renal care professionals’ perceived barriers and facilitators for use of bioimpedance in clinical practice.MethodsQualitative data were collected through four focus group interviews with 24 renal care professionals: dieticians, nephrologists and nurses, recruited voluntarily from a nation-wide selection of hemodialysis centers, having access to a bioimpedance-device. The participants were connected to each other and a moderator via equipment for telemedicine and the sessions were recorded. The interviews were semi-structured, focusing on the participants’ perceptions of use of bioimpedance in clinical practice. Thematic content analysis was performed in consecutive steps, and data were extracted by employing an inductive, interactive, comparative process.ResultsSeveral barriers and facilitators to the use of bioimpedance in clinical practice were identified, and a multilevel approach to examining barriers and incentives for change was found to be applicable to the ideas and categories that arose from the data. The determinants were categorized on five levels, and the different themes of the levels illustrated with quotations from the focus groups participants.ConclusionsDeterminants for use of bioimpedance were identified on five levels: 1) the innovation itself, 2) the individual professional, 3) the patient, 4) the social context and 5) the organizational context. Barriers were identified in the areas of credibility, awareness, knowledge, self-efficacy, care processes, organizational structures and regulations. Facilitators were identified in the areas of the innovation’s attractiveness, advantages in practice, and collaboration. Motivation, team processes and organizational capacities appeared as both barriers and facilitators.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-0907-4) contains supplementary material, which is available to authorized users.

Fluid and hemodynamic management in hemodialysis patients: challenges and opportunities

“…In addition, extensive use of BIS in clinical studies has generated substantial evidences showing that BIS was able to detect subtle fluid volume variation 63,64,65 and to support the notion that more precise fluid management might improve intermediate outcomes and dialysis patient endpoints 66,67,68 . Few prospective clinical trials in advanced kidney disease or dialysis patients are ongoing to define more precisely the value of BIS in managing fluid status and its impact on preservation of residual kidney function and on cardiovascular outcomes 69,70 .…”

Patient and Staff Perceptions on Using Bioelectrical Impedance Analysis in an Outpatient Haemodialysis Setting: A Qualitative Descriptive Study

“…Renal care professionals have previously reported limited self-efficacy due to lack of BIA knowledge and skills, and reduced capacity to manage the dialysis care process, as barriers to systematic uptake and use of BIA in practice [ 29 ]. In the current study, nurses and dietitians identified limited staffing and clinical time, and competing clinical priorities as the most significant barriers to uptake.…”

Systematic Fluid Assessment in Haemodialysis: Development and Validation of A Decision Aid

“…; Stenberg et al . ). Although we aimed for the RECOVA tool to be simple, we acknowledge that nurses found it difficult to comprehend the algorithm of the decision aid—reflecting the complexity of target weight determination—and this may be considered a limitation of the tool.…”

“…In IRR analysis, raters achieved less agreement when assessing patients where clinical symptoms and BIS conflicted (direction A or C). Poor knowledge of the limitations of BIS, as discussed above, may be one explanation for the limited implementation of BIS in clinical practice (Dasgupta et al 2016;Stenberg et al 2016Stenberg et al , 2018. Although we aimed for the RECOVA tool to be simple, we acknowledge that nurses found it difficult to comprehend the algorithm of the decision aid-reflecting the complexity of target weight determination-and this may be considered a limitation of the tool.…”