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

Jenny Stenberg,Catrin Henriksson,Magnus Lindberg,Hans Furuland

doi:10.1186/s12882-018-0907-4

Jenny Stenberg, Catrin Henriksson + Show 2 more

Open Access

https://doi.org/10.1186/s12882-018-0907-4

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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.

Highlights

Inadequate volume control may be a main contributor to poor survival and high mortality in hemodialysis patients
Determinants for use of bioimpedance in hemodialysis were identified on five levels (Table 1): 1) the innovation itself, 2) the individual professional, 3) the patient, 4) the social context and 5) the organizational context
Innovation Barriers Several users had been enthusiastic about bioimpedance initially, but expressed declining confidence in the method

Summary

Introduction

Inadequate volume control may be a main contributor to poor survival and high mortality in hemodialysis patients. Assessing hydration status and achieving an adequate dry weight in dialysis patients is a delicate task; morbidity and mortality, primarily due to cardiovascular disease, remain unacceptably high, and emerging evidence suggests inadequate volume control as a main contributor [1,2,3]. Fluid volume status is based on clinical examination, but a number of technologies are available to aid assessment [6, 7]. In recent randomized controlled trials, regression of left ventricular mass index, decrease in blood pressure, improved arterial stiffness and improved survival were demonstrated in hemodialysis patients when bioimpedance spectroscopy was used to guide dry weight adjustments [10, 11].

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