title: Patient-stated preferences regarding volume-related risk mitigation strategies for hemodialysis.
abstract: OBJECTIVE
  Larger weight gain and higher ultrafiltration rates have been associated with poorer outcomes among patients on dialysis. Dietary restrictions reduce fluid-related risk; however, adherence is challenging. Alternative fluid mitigation strategies include treatment time extension, more frequent dialysis, adjunct peritoneal dialysis, and wearable ultrafiltration devices. No data regarding patient preferences for fluid management exist. A survey was designed, tested, and administered to assess patient-stated preferences regarding fluid mitigation.
  
  
  METHODS
  A written survey concerning fluid-related symptoms, patient and treatment characteristics, and fluid management preferences was developed. The cross-sectional survey was completed by 600 patients on hemodialysis at 18 geographically diverse ambulatory facilities. Comparisons of patient willingness to engage in volume mitigation strategies across fluid symptom burden, dietary restriction experience, and patient characteristics were performed.
  
  
  RESULTS
  Final analyses included 588 surveys. Overall, if allowed to liberalize fluid intake, 44.6% of patients were willing to extend treatment time by 15 minutes. Willingness to extend treatment time was incrementally less for longer treatment extensions; 12.2% of patients were willing to add a fourth weekly treatment session, and 13.5% of patients were willing to participate in nocturnal dialysis three nights per week. Patients more bothered by their fluid restrictions (versus less bothered) were more willing to engage in fluid mitigation strategies. Demographic characteristics and symptoms, such as cramping and dyspnea, were not consistently associated with willingness to engage in the proposed strategies. More than 25% of patients were unsure of their dry weights and typical interdialytic weight gains.
  
  
  CONCLUSIONS
  Patients were generally averse to treatment time extension>15 minutes. Patients more bothered (versus less bothered) by their prescribed fluid restrictions were more willing to engage in volume mitigation strategies. Additional study of patient-stated preferences in hemodialysis treatment practices is needed to guide patient care and identify deficiencies in patient treatment and disease-related knowledge.
authors.affiliation: Renal Division and Harvard Medical School, Boston, Massachusetts;
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Flythe
authors.affiliation: Health Services Division, John Snow, Inc., Boston, Massachusetts; and.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Mangione
authors.affiliation: Renal Division and DaVita Clinical Research, Minneapolis, Minnesota.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Brunelli
authors.affiliation: Renal Division and Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts;
authors.forename: Gary C
authors.initials: GC
authors.lastname: Curhan
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D003430:Cross-Sectional Studies; D004326:Drinking; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D057240:Patient Preference; D055656:Prescriptions; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D015430:Weight Gain
keywords: ESRD; hemodialysis; ultrafiltration