UK National Survey of Practice Patterns of Fluid Volume Management in Haemodialysis Patients: A Need for Evidence

Blood Purif. 2016;41(4):324-31. doi: 10.1159/000444246. Epub 2016 Feb 11.


Background: Fluid management in haemodialysis (HD) affects patient experience, morbidity and mortality. Standards for best practice are lacking. A national survey of the United Kingdom was undertaken to define prevalent practice.

Methods: An online questionnaire was distributed to all UK renal centres.

Results: Forty-five of 74 centres (173 dialysis units), serving 62% (n = 14,697) of UK HD population responded. Seventy-eight per cent had no agreed policy for managing fluid balance in patients on HD; 44% did not assess fluid status routinely. Clinical assessment was the norm; 27% used bio-impedance-based device. To achieve a target-weight, 53% reduced weight as far as tolerated. Twenty-two per cent measured residual renal function (RRF). Ninety-one per cent had no policy for fluid overload. Sixty-four per cent restricted salt and water. Ninety-three per cent used diuretics in patients with RRF. Thirty-eight per cent felt management was adequate; 77% felt there was a need for better evidence. Ninety-one per cent would participate in a study addressing this.

Conclusion: There is an urgent need for establishing an evidence base on the optimal approaches to fluid management.

MeSH terms

  • Diet / methods
  • Disease Management
  • Diuretics / therapeutic use
  • Electric Impedance
  • Fluid Therapy / methods
  • Fluid Therapy / standards*
  • Health Surveys
  • Humans
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / physiopathology
  • Kidney Failure, Chronic / therapy*
  • Practice Patterns, Physicians' / standards*
  • Renal Dialysis / methods
  • Renal Dialysis / standards*
  • Surveys and Questionnaires
  • Survival Analysis
  • United Kingdom
  • Water-Electrolyte Balance / physiology


  • Diuretics