Abstract
AbstractRationale & ObjectiveExcessive interdialytic weight gain (IDWG) is associated with increased cardiovascular risk in hemodialysis patients. We aimed to reduce excessive IDWG events by 50% over two years using a multi-interventional quality improvement approach. Study DesignProspective, single-center, multi-modal QI initiative using Plan-Do-Study-Act (PDSA) cycles. Setting & ParticipantsAll pediatric and young adult patients (<27 years old) receiving outpatient hemodialysis at a single pediatric dialysis center (n=17; 4,166 sessions) from June 2020 to June 2022. ExposuresInterventions included individualized chairside education, dialysis nurse-driven patient communication, monthly IDWG tracking in team meetings, and a reduction in dialysate sodium concentration from 140 to 137 mEq/L. OutcomesThe primary outcome was percent of hemodialysis sessions with excessive IDWG (≥5%). Balancing measures included additional dialysis sessions, serum sodium levels, blood pressure trends, and dialysis nurse documentation burden. Analytical ApproachStatistical process control (SPC) charts assessed outcome trends. Student’s t-test compared pre- and post-intervention data. SPC chart centerlines and control limits identified special cause variation. ResultsAt baseline, 39% of dialysis sessions showed excessive IDWG. Following the full implementation of interventions, the mean shifted to 19%, representing a 51% reduction. The dialysate sodium change and nurse-driven communication had the greatest impact. There were no significant changes in blood pressure, serum sodium, or additional dialysis sessions. Documentation time added per session averaged <3 minutes. LimitationsWe did not extract patient-level clinical data such as baseline hypertension, cardiac comorbidities, adherence metrics, level of engagement in psychology, or antihypertensive medication adjustments. ConclusionsA multidisciplinary, multimodal QI intervention significantly reduced the frequency of excessive IDWG in pediatric dialysis patients. Lowering dialysate sodium and nurse-led counseling were particularly impactful without increasing treatment burden. Future work should focus on sustainability, behavioral health integration, and long-term cardiovascular outcomes.