Measurement and mobilisation of localised oedema in haemodialysis

Background

The presence of localised oedema can make measurement and removal of excess fluid in haemodialysis challenging.

Objectives

To evaluate (i) the effectiveness of intermittent pneumatic compression and neuromuscular electrical stimulation at mobilising oedema and (ii) the impact of localised fluid on bioimpedance measured fluid status.

Design

A single centre, cross-over study design. Participants were monitored weekly during mid-week dialysis sessions. Four sessions with each of the interventions and no interventions, with washout periods between, were included.

Participants

Six participants with lower limb oedema and established on haemodialysis for at least 3 months.

Measurements

The effectiveness of mobilising oedema and improving haemodynamic stability was assessed by: reduction in ankle circumference; ultrafiltration volume achieved; blood pressure changes; participant symptoms and achievement of target weight. The impact of localised fluid on bioimpedance measurements was assessed by comparing measurements across affected tissue with measurements avoiding the site of oedema.

Results

There were no differences in ultrafiltration volumes, achievement of target weight, participant symptoms or reductions in ankle circumference and systolic blood pressure between intermittent pneumatic compression and neuromuscular electrical stimulation sessions compared to control sessions. Measurements of fluid overload with bioimpedance were 1.7 and 1.8 L higher when measuring across oedematous tissue compared to non-oedematous tissue.

Conclusions

We were unable to demonstrate improved mobilisation of fluid in the participant's lower limb, though there was a low number of study participants and notable interindividual variation observed. Bioimpedance offers potential for monitoring fluid management in individuals with lower limb oedema but specific protocols are necessary.