KHI Current Project
Fostering Innovation in Fluid Management
Achievement of optimal salt and water balance after dialysis is a primary goal of renal replacement therapy (RRT). Inadequate fluid management leads to significant morbidity and mortality from complications of hypervolemia and hypovolemia. We lack technologies to accurately assess volume status. Therefore, the clinical approach to volume assessment is subjective and involves trial and error. Insufficient innovation in the fluid management space over the last two decades, provides a clear need to stimulate innovation and collaboration across stakeholders in that arena. KHI is uniquely positioned to forge these collaborations. We believe improving fluid management will substantially improve patient clinical and patient-reported outcomes.
A document that outlines the technical design requirements of an ideal, future device to help patients and/or clinicians manage a person's fluid before, during, after and in between dialysis treatments.
Completion goal of Summer 2019
"Denying yourself a cold glass of water is the worst. Everywhere you look, as a dialysis patient, you see beverages: water, ice, sodas, coffee, tea, slushies,… did I say water?" -51-year-old woman on hemodialysis
Achieving the optimal fluid balance with dialysis is extremely difficult. When too much fluid is removed or fluid is removed too quickly, cramps and fatigue often occur. When too little fluid is removed or if patients have too large of weight gains between treatments, bloating, shortness of breath and fatigue often occur. Knowing how much fluid to remove is a huge challenge and is far from a precise science. Such adverse clinical sequelae of imprecise fluid management have substantial impact on long-term clinical and patient-reported outcomes. Chronic volume overload, clinical or subclinical, is associated with increased hospitalizations and mortality. Hypovolemia, either due to inaccurate dry weight estimation or overly rapid fluid removal during dialysis, is associated with clinical and subclinical end-organ ischemia that can lead to long-term organ damage and dysfunction.[2-5, 7, 8] These fluid-related challenges are associated not only with substantial patient morbidity and mortality, but also with high health care system utilization and costs.
One of the most challenging issues for dialysis patients and their healthcare providers is accurately determining an individual's ideal weight (dry/target weight). Despite all the technological and engineering advances in medicine over the last several decades, there has been surprisingly little innovation when it comes to volume status estimation. Devices such as non-invasive blood volume monitoring, bioimpedance and lung ultrasound have shown some promise. However, there is currently no FDA-approved device for body weight/composition determination. This is a critical gap in care that has vast implications for patient quality of life and clinical outcomes.
Inspired by advances in glucose monitoring and fitness tracking, this project challenges the community to consider innovations that might involve wearables devices with real-time feedback so patients can adjust their behaviors in response to fluid status as well as other innovative technologies that move us away from dependence on in-clinic monitoring devices.
- Summarize patient priorities
- Standardize definitions and terminology
- Catalogue existing and under-development relevant technologies with needs assessment
- Produce a guide and stimulate device innovation in fluid management
|Co-Chair||Derek Forfang||National Kidney Foundation|
|Co-Chair||Yossi Chait, MS, PhD||University of Massachusetts Amherst|
|Member||Gwen Derk||University of Illinois Urbana-Champaign|
|Member||Nathan Gooch, PhD||Becton Dickinson (BD)|
|Member||Barbara A. Greco, MD||Tufts University School of Medicine|
|Member||Tzu-Jen Kao, MD, PhD||GE Global Research|
|Member||Conall O'Seaghdha, MRCPI||patientMpower|
|Member||Erinn S. Reilly||FAST BioMedical|
|Member||Jesse Roach||Centers for Medicare and Medicaid Services|
|Member||Amy J. Steig, PhD||GraftWorx|
|Member||Isaac Teitelbaum, MD, FACP||University of Colorado Denver|
|Member||Caroline Wilkie||KHI Patient & Family Partnership|
|Member||Kenneth R. Wilund, PhD||University of Illinois Urbana-Champaign|
|Board of Directors Liaison||Jennifer Flythe, MPH, MD, FASN||UNC School of Medicine|
|Staff Liaison||Meaghan Allain||Kidney Health Initiative|