#2610 nurse-led optimization of volume and blood pressure in kidney disease – enabling at multi-levels using a technology (novelty) program

Abstract Background and Aims Fluid overload and hypertension are common in chronic kidney disease (CKD). They increase healthcare utilization due to frequent ambulatory consults and/or hospitalizations but can be avoided with self-management. We evaluated the feasibility of a nurse-led, team-based program that incorporated (1) objective fluid volume assessment using body impedance analysis (BIA) to enable diuretic and antihypertensive titration, and (2) structured patient education and action plan coaching for ambulatory patients with CKD and fluid overload and/or uncontrolled blood pressure. Method Prospective pilot study of adults who participated in the 4-week program (Figure 1) between August and October 2022. Patients were eligible if they had CKD not requiring dialysis and had fluid overload and/or systolic blood pressure (BP) >160 mmHg or diastolic BP >100 mmHg at the ambulatory renal clinic. We evaluated fluid overload symptoms and signs, standardized clinic BP, BIA over-hydration volume and patient reported outcomes on (1) chronic disease self-management using the Partner in Health (PIH) questionnaire (2) perceived autonomy support from the healthcare team using the modified Health Care Climate Questionnaire (HCCQ), and (3) health-related quality of life (HrQOL) using the EuroQOL-5 Dimension (EQ5D5L) questionnaire, before and after the program. Results Fifteen patients were referred by their nephrologists, but 1 was uncontactable and 1 did not want to adhere to the recommended treatment. Among 13 patients in the pilot, 64.3% was male, median age was 68 (range 40 – 85) years and 35.7% had ≥4 visits to healthcare institutions in the past six months. Causes of kidney disease were diabetes (64.3%), hypertension (21.4%) and glomerulonephritis (14.3%), with a median eGFR of 30 (14 – 106) ml/min/1.73 m2. At enrolment, fluid overload was present in 57.1% and BIA over-hydration value was 1.7L (0 – 6.4L). Eleven patients (84.6%) completed the 4-week follow-up; 1 stopped after the first consult due to lack of time, while 1 stopped after 2 weeks (already confident of self-management). At 4 weeks, systolic BP [141 (109-179) mmHg versus 162 (120-198) mmHg at enrolment, p = 0.046] and PIH score [84 (72-96) versus 57 (10-94), p = 0.04] had improved significantly compared to enrolment, while HrQOL was not different (Table 1). Patients generally perceived a high level of autonomy support from the healthcare team. Serum creatinine did not change significantly after antihypertensive and diuretic titration. Conclusion A nurse-led program incorporating objective fluid volume assessment, structured patient education and action plan coaching was well-received, with improved BP and self-management in patients with kidney disease.