Effect of the fluid management nursing intervention on improving biochemical test results and dialysis therapy in chronic kidney disease patients: a randomized controlled trial

Classified as probably not a substantial claim. May combine two claims.

Precise control of fluid and electrolyte balance, careful clinical observation, analysis of laboratory and biochemical test results, and measurement of dialysis adequacy achieve the goal of improving biochemical/laboratory results and quality of life/safety.

“This goal will be achieved through precise control of fluid and electrolyte balance, careful evaluation of clinical observation and analysis of laboratory and biochemical test results, and measurement of dialysis adequacy for these patients.9”

• cites [9] Agrawaal KK Kandel S Devkota S Mean Urea Reduction Ratio among Patients Undergoing Hemodialysis at a Tertiary Care Centre: A Descriptive Cross-sectional Study Journal of the Nepal Medical Association 2023 61 446 450 37203887 PMC10896452 sourcePartly supported

  The Introduction (page unavailable) says dialysis adequacy is measured using URR or Kt/V, and the Methods (page unavailable) say the study recorded clinical and laboratory parameters. The paper does not say that precise fluid and electrolyte control or careful clinical observation, together with those measurements, will achieve improved laboratory results or quality of life and safety. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Several blood components and clinical/laboratory markers are altered in chronic kidney disease patients on hemodialysis.

“Several blood components and clinical/laboratory markers are altered in CKD patients on hemodialysis.16”

• cites [16] Portales-Castillo I Rieg T Khalid SB Nigwekar SU Neyra JA Physiopathology of phosphate disorders Advances in Kidney Disease and Health 2023 30 2 177 188 36868732 PMC10565570 sourceSupported

May combine two claims.

The persistence of hypervolemia in 94.1% of the control group may justify the marked deterioration in the quality of hemodialysis in these patients, since excess fluid volume directly affects the quality of dialysis in patients with chronic kidney disease.

“The persistence of hypervolemia in 94.1% of the CG may justify the marked deterioration in the quality of hemodialysis in these patients, since EFV directly affects the quality of dialysis in patients with chronic kidney disease.28”

• cites [28] Masakane I Ito M Tanida H Nawano T Patient-Centered Care Could Improve Quality of Life and Survival of Dialysis Patients: Dialysis Prescription and Daily Practice Blood Purification 2023 52 44 55 PMC10210077 36702112 sourcePartly supported

  Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

Mean values of URR and Kt/V in hemodialysis patients serve as critical indicators of dialysis adequacy in chronic kidney disease, guiding multidisciplinary care tailored to patient needs.

“The mean values of URR and Kt/V in hemodialysis patients serve as critical indicators of dialysis adequacy in chronic kidney disease, guiding multidisciplinary care tailored to patient needs.9”

• cites [9] Agrawaal KK Kandel S Devkota S Mean Urea Reduction Ratio among Patients Undergoing Hemodialysis at a Tertiary Care Centre: A Descriptive Cross-sectional Study Journal of the Nepal Medical Association 2023 61 446 450 37203887 PMC10896452 sourcePartly supported

  The Introduction (page unavailable) says dialysis adequacy is estimated using URR and/or Kt/V, and the Results report mean values for both. The Discussion calls for measures to improve dialysis quality, but the paper does not say these measures involve multidisciplinary care tailored to individual patient needs. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

Hypervolemia directly affects the quality of dialysis, and its elimination contributed to more effective dialysis.

“Hypervolemia directly affects the quality of dialysis, and its elimination contributed to more effective dialysis.”

• cites [28] Masakane I Ito M Tanida H Nawano T Patient-Centered Care Could Improve Quality of Life and Survival of Dialysis Patients: Dialysis Prescription and Daily Practice Blood Purification 2023 52 44 55 PMC10210077 36702112 sourceCould not verify

  The Dialysis Quality Evaluation section discusses dialysis quality in terms of solute removal, biocompatibility, and patient-reported outcomes, not hypervolemia. Searches for hypervolemia, fluid overload, volume status, and fluid removal found no passage saying that eliminating hypervolemia made dialysis more effective. Page numbers were unavailable in our copy. (LLM, conf=0.74)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In a recent cross-sectional study of 100 hemodialysis patients, the average URR was 25.24±15.59, and Kt/V was 0.73±0.162.

“In a recent cross-sectional study of 100 hemodialysis patients, the average URR was 25.24±15.59, and Kt/V was 0.73±0.162.9”

• cites [9] Agrawaal KK Kandel S Devkota S Mean Urea Reduction Ratio among Patients Undergoing Hemodialysis at a Tertiary Care Centre: A Descriptive Cross-sectional Study Journal of the Nepal Medical Association 2023 61 446 450 37203887 PMC10896452 sourceSupported

May combine two claims.

URR decreased significantly from 73.3±7.4 to 69.7±12.9 (p=0.001), with the most pronounced reduction observed in the control group compared to the intervention group (p=0.003).

“URR decreased significantly from 73.3±7.4 to 69.7±12.9 (p=0.001), with the most pronounced reduction observed in CG compared to IG (p=0.003).”

May combine two claims.

The post-intervention increase in calcium was statistically significant in both the control group (p=0.015) and the intervention group (p=0.013).

“The post-intervention increase was statistically significant in both CG (p=0.015) and IG (p=0.013).”

May combine two claims.

The decline in Kt/V was driven by the control group (from 1.6±0.4 to 1.4±0.5), while the intervention group maintained Kt/V (1.6±0.3).

“This decline was driven by CG (from 1.6±0.4 to 1.4±0.5), while IG maintained Kt/V (1.6±0.3).”

May combine two claims.

Between-group differences in post-hemodialysis urea were significant for the control group (p=0.002) and marginally non-significant for the intervention group (p=0.057).

“Between-group differences were significant for CG (p=0.002) and marginally non-significant for IG (p=0.057).”

May combine two claims.

Post-hemodialysis urea improved in the intervention group and worsened in the control group after the intervention, with significant results.

“On the other hand, post-hemodialysis urea improved in IG and worsened in CG after the intervention, with significant results.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Carvedilol 25 mg use was 26.5% overall, with one in the control group and eight in the intervention group, a statistically significant difference (p=0.017).

“In general, there was no significant difference in the distribution of medications (p > 0.05), except for carvedilol 25 mg: 26.5% (n = 9) of participants used this drug, with one in the control group and eight in the intervention group, showing a statistically significant difference (p = 0.017).”

May combine two claims.

The deterioration in dialysis quality in the control group was significant (p<0.001), while the intervention effectively maintained dialysis quality without significantly altering this measure (p=0.521).

“The deterioration in dialysis quality in CG was significant (p<0.001), while the intervention effectively maintained dialysis quality without significantly altering this measure (p=0.521).”

May combine two claims.

Mean post-hemodialysis urea increased significantly from 32.4±14.1 to 39.0±19.9 (p<0.001), with 100% (n=34) of the sample experiencing a change.

“Mean post-hemodialysis urea increased significantly from 32.4±14.1 to 39.0±19.9 (p<0.001), with 100% (n=34) of the sample experiencing a change.”

May combine two claims.

Mean calcium levels increased from 9.1±0.5 to 9.4±0.2 (p<0.001), remaining within the normal range.

“Mean calcium levels increased from 9.1±0.5 to 9.4±0.2 (p<0.001), remaining within the normal range.”

May combine two claims.

Post-intervention, mean hematocrit was 40.1±4.3 in the control group and 37.6±4.4 in the intervention group, with no significant difference (p=0.104).

“Post-intervention, these values were 40.1±4.3 in CG and 37.6±4.4 in IG, with no significant difference observed (p=0.104).”

May combine two claims.

The prevalence of individuals developing anemia increased more in the control group (from 17.6% to 29.4%) than in the intervention group (from 47% to 52.9%), a statistically significant difference (p=0.006).

“The prevalence of individuals developing anemia increased more in CG (from 17.6% to 29.4%) compared to IG (from 47% to 52.9%), a statistically significant difference (p=0.006).”

May combine two claims.

Regarding URR, 29.4% (n=5) of control group participants showed a decrease, contrasting with 100% (n=17) of intervention group participants showing no change (p=0.04).

“Regarding URR, 29.4% (n=5) of CG participants showed a decrease, contrasting with 100% (n=17) of IG participants showing no change (p=0.04).”

May combine two claims.

At baseline, mean hematocrit was 43.3±4.1 in the control group and 37.1±5.0 in the intervention group, a significant difference (p<0.001).

“At baseline, the mean hematocrit was 43.3±4.1 in CG and 37.1±5.0 in IG, indicating a significant group difference (p<0.001).”

May combine two claims.

Mean creatinine increased from 8.9±3.1 to 9.7±3.0 (p=0.002), with no significant between-group differences observed (p=0.006 for the control group and p=0.09 for the intervention group).

“Mean creatinine increased from 8.9±3.1 to 9.7±3.0 (p=0.002), with no significant between-group differences observed (p=0.006 for CG and p=0.09 for IG).”

May combine two claims.

At baseline, 11.8% (n=4) of participants showed negative changes in calcium, while post-intervention 100% (n=34) had no change, indicating a significant difference (p=0.031).

“Regarding calcium, 11.8% (n=4) of participants showed negative changes at baseline, while 100% (n=34) had no change post-intervention, indicating a significant difference (p=0.031).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Urea was altered in nearly 100% of the pre- and post-hemodialysis samples.

“Urea, a waste product produced by the breakdown of proteins and eliminated from the blood by the kidneys21, was altered in nearly 100% of the pre- and post-hemodialysis samples.”

May combine two claims.

Only 11.8% had lower calcium levels before the procedure, and none of the patients had hypocalcemia after the procedure, even those who had been on dialysis for 56.6±29.7 months.

“Only 11.8% had lower calcium levels before the procedure, and none of the patients had hypocalcemia after the procedure, even those who had been on dialysis for 56.6±29.7 months.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Altered and elevated creatinine levels were present in the entire sample before and after the intervention, as expected due to the physiological aspects of the disease, as well as a high prevalence of hyperphosphatemia.

“It should be noted that altered and elevated creatinine levels were present in the entire sample before and after the intervention, as expected due to the physiological aspects of the disease, as well as a high prevalence of hyperphosphatemia.”

May combine two claims.

Furosemide use was present in 23.5% of the control group and 35.3% of the intervention group, with no statistically significant difference (p=0.708).

“The data analyzed showed that this medication was present in 23.5% of the control group and 35.3% of the intervention group, but this difference was not statistically significant (p=0.708).”

May combine two claims.

Post-intervention hemoglobin values were comparable between the control group (12.4±1.4) and intervention group (12.0±1.6), with no significant difference (p=0.373).

“Post-intervention, values were comparable: CG (12.4±1.4) and IG (12.0±1.6), with no significant difference detected (p=0.373).”

May combine two claims.

Our study found a baseline URR of 73.3±7.4, which decreased to 69.7±12.9 post-intervention, primarily due to deterioration observed in the control group.

“Similarly, our study found a baseline URR of 73.3±7.4, which decreased to 69.7±12.9 post-intervention, primarily due to deterioration observed in the CG.”

May combine two claims.

This study showed a significant deterioration in Kt/V in the control group, from 1.6±0.4 to 1.4±0.5, while in the intervention group the average remained at 1.6±0.3, although one patient in this group had an unbalanced Kt/V.

“As for Kt/V, this study showed a significant deterioration in CG, from 1.6±0.4 to 1.4±0.5, while in IG the average remained at 1.6±0.3, although one patient in this group had an unbalanced Kt/V.”

May combine two claims.

Proper hemodialysis management and implementation of the intervention corrected or helped maintain these components within recommended serum concentrations, preventing hemodynamic instability and adverse human reactions.

“Proper hemodialysis management and implementation of the intervention corrected or helped maintain these components within recommended serum concentrations, preventing hemodynamic instability and adverse human reactions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Linear regression was used to adjust risk estimates for furosemide as a potential confounder.

“Nevertheless, we decided to use linear regression to adjust the risk estimates to account for this confounding variable and its possible relationship with the outcome variables.”

May combine two claims.

Outcome assessors (laboratory staff) and the statistician were blinded to group assignment, while participants were aware of their allocation.

“Although participants were aware of their group allocation due to the nature of the intervention, the trial adopted a double-blind design since both outcome assessors (laboratory staff) and the statistician were blinded to group assignment. Clinical staff at the dialysis center were also not informed of which patients belonged to each group.”

May combine two claims.

Baseline distribution of eight of ten laboratory parameters (phosphorus, potassium, calcium, pre-hemodialysis urea, post-hemodialysis urea, URR, creatinine, Kt/V) was comparable between groups, with no statistically significant differences (p>0.005).

“Among the ten parameters evaluated, there were no statistically significant differences (p>0.005) in eight of them (Phosphorus, Potassium, Calcium, Pre-Hemodialysis Urea, Post-Hemodialysis Urea, URR, Creatinine, Kt/V) (Table 2).”

Probably not a substantial claim: may not pass S2 (checkable).

Nurses play an essential role in maintaining adequate electrolyte and laboratory balance in hemodialysis patients.

“nurses play an essential role in maintaining adequate electrolyte and laboratory balance, assuming responsibilities that range from direct assistance during hemodialysis therapy to educating and guiding patients on various aspects of self-care and management of the individual's renal and general condition.7”

• cites [7] Beetham KS Krishnasamy R Stanton T Sacre JW Douglas B Isbel NM Effect of a 3-year lifestyle intervention in patients with chronic kidney disease: A randomized clinical trial Journal of the American Society of Nephrology 2022 33 431 441 34893535 PMC8819984 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

The deterioration observed in the intervention group may be attributed to inadequate reinforcement of nutritional care and failure to improve uremia.

“The deterioration observed in the IG may be attributed to inadequate reinforcement of nutritional care and failure to improve uremia.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The trial was registered in the Brazilian Clinical Trials Registry (REBEC) under RBR-2DD6X6R.

“The study was also registered in the Brazilian Clinical Trials Registry (REBEC) - RBR-2DD6X6R.”

May combine two claims.

The intervention helped maintain hematocrit and hemoglobin levels in the intervention group, while there was a significant deterioration in the control group.

“The intervention helped maintain hematocrit and hemoglobin levels in the IG, while there was a significant deterioration in the CG.”

May combine two claims.

The improvement in the intervention group is related to the increase in the prevalence of patients who started to urinate after the intervention, with a statistical difference, and to the nutritional advice given for a balanced protein intake.

“The improvement in IG is related to the increase in the prevalence of patients who started to urinate after the intervention, with a statistical difference, and to the nutritional advice given for a balanced protein intake.”

May combine two claims.

Baseline hematocrit and hemoglobin differed significantly between the control and intervention groups (p<0.001 and p=0.002, respectively).

“However, baseline comparison between CG and IG revealed significant differences in hematocrit (p<0.001) and hemoglobin (p=0.002).”

Classified as probably not a substantial claim.

All activities described in the intervention were fully implemented.

“All the activities described in this intervention, both those that contribute directly and those that contribute indirectly to the achievement of the proposed objective, were fully implemented.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

No formal sample size calculation was conducted; a convenience sample of all eligible patients from the finite population was adopted.

“No formal sample size calculation was conducted; instead, a convenience sample comprising all eligible patients from this finite population was adopted.”

• AssumptionRests on an assumption: The population was finite and relatively small.

May combine two claims.

Nursing interventions supported by the Nursing Interventions Classification have the potential to improve biochemical and laboratory test results in patients with end-stage CKD and to improve quality of life and safety.

“The interventions envisaged by nurses in this context, especially those supported by the Nursing Interventions Classification (NIC), not only have the potential to improve the results of biochemical and laboratory tests in patients with end-stage CKD, but also aim to significantly improve the patient's quality of life and safety.8”

• cites [8] Voltarelli BC Ruzzi-Pereira A Occupational performance of chronic kidney patients undergoing hemodialysis Revista Família, Ciclos de Vida e Saúde no Contexto Social (REFACS) 2021 9 631 641Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The routine intervention may have contributed to the serum improvement of calcium in both groups, given the improvement in the control group.

“However, it should be considered that the routine intervention may have contributed to the serum improvement of this element in both groups, given the improvement in CG.”

May combine two claims.

Both groups received the same routine dialysis care, with the structured nursing protocol being the only additional component for the intervention group.

“Both groups received the same routine dialysis care, with the structured nursing protocol being the only additional component for the intervention group.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Randomization was conducted by an independent staff member using the Research Randomizer application, with simple 1:1 randomization without blocks or restrictions.

“Randomization was conducted by an independent staff member, not otherwise involved in the study, using the Research Randomizer application. The allocation sequence was generated with simple 1:1 randomization, without blocks or restrictions.”

May combine two claims.

By controlling intravascular fluid, the intervention helped prevent changes in hematocrit and serum hemoglobin parameters and associated complications, thereby improving patients' quality of life.

“By controlling intravascular fluid, the intervention helped prevent changes in hematocrit and serum hemoglobin parameters and associated complications, thereby improving patients' quality of life.”

May combine two claims.

The nursing intervention significantly improved laboratory test results and dialysis adequacy in patients with chronic renal failure and Excess Fluid Volume.

“There were significant improvements in laboratory test results and dialysis adequacy.”

• Also stated in: § Conclusion. · plain

  “The nursing intervention significantly improved laboratory test results and dialysis adequacy in patients with chronic renal failure and Excess Fluid Volume, highlighting its potential for enhancing patient management and nursing care.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The study was approved by the Institutional Research Ethics Committee under CAAE 56761422.6.0000.5576, and all participants signed written informed consent.

“The research strictly complied with ethical and legal principles, was approved by the Institutional Research Ethics Committee for studies involving human subjects under registration number CAAE 56761422.6.0000.5576, and all participants signed a written informed consent form.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Of 139 screened patients, 34 were included in the final sample after exclusions and dropouts.

“After applying the inclusion, exclusion, discontinuation, and dropout criteria, 34 individuals were included in the study.”

May combine two claims.

Electrolyte imbalance in patients with CKD can lead to water overload, serious cardiac complications, muscle weakness, neurological and renal problems, worsening prognosis.

“Electrolyte imbalance in this population can lead to water overload, serious cardiac complications, muscle weakness, neurological and renal problems, worsening their prognosis.3”

• cites [3] Sampani E Theodorakopoulou M Iatridi F Sarafidis P Hyperkalemia in chronic kidney disease: a focus on potassium lowering pharmacotherapy Expert Opinion on Pharmacotherapy 2023 24 1775 1789 37545002 sourceNot checked — no full text of the source

May combine two claims.

The difference between the mean results for URR and Kt/V validate the intervention and show that its implementation had an influence on improving the quality of dialysis in the intervention group.

“The difference between the mean results for URR, urea reduction rate considering its pre-HD and post-HD values, and Kt/V, validate the intervention and show that its implementation had an influence on improving the quality of dialysis in the IG.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The laboratory test results were provided by the dialysis center itself and it was not possible to include other blood components.

“It should be emphasized that the laboratory test results were provided by the dialysis center itself and it was not possible to include other blood components.”

May combine two claims.

The statistical difference between the groups was remarkable for the mean values of calcium, post-hemodialysis urea and creatinine, demonstrating the direct impact of the intervention.

“The statistical difference between the groups was remarkable for the mean values of calcium, post-hemodialysis urea and creatinine, demonstrating the direct impact of the intervention.”

Classified as probably not a substantial claim. May combine two claims.

Normal thresholds for Kt/V are typically above 1.20, and for URR, above 65%.

“Normal thresholds for Kt/V are typically above 1.20, and for URR, above 65%.27”

• cites [27] Raimann JG Ye X Kotanko P Daugirdas JT Routine Kt/V and normalized protein nitrogen appearance rate determined from conductivity access clearance with infrequent postdialysis serum urea nitrogen measurements American Journal of Kidney Diseases 2020 76 22 31 32220509 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Persistently elevated serum creatinine is a diagnostic and prognostic feature of chronic kidney disease itself.

“This result was expected, as persistently elevated serum creatinine is a diagnostic and prognostic feature of CKD itself.25”

• cites [25] Gaitonde DY Cook DL Rivera IM Chronic kidney disease: detection and evaluation American Family Physician 2017 96 776 783 29431364Not checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

By analyzing biochemical test results and dialysis adequacy measures, nurses can identify early clinical changes and variations in electrolyte levels and other laboratory tests, allowing timely implementation of the evaluated intervention to mitigate complications and improve dialysis adequacy measures.

“By analyzing biochemical test results and dialysis adequacy measures, nurses can identify early clinical changes and variations in electrolyte levels and other laboratory tests, allowing timely implementation of the evaluated intervention to mitigate complications and improve dialysis adequacy measures.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Other tests, such as serum glucose, were not analyzed because not all patients underwent the same tests in addition to the routine tests, which are prescribed only when necessary, making further comparisons impossible.

“Other tests, such as serum glucose, were not analyzed because not all patients underwent the same tests in addition to the routine tests, which are prescribed only when necessary, making further comparisons impossible.”

May combine two claims.

With the positive impact of the intervention evident in stable hemodialysis patients, as indicated by stable or improved post-intervention test results without significant fluctuations, the intervention could effectively address electrolyte and blood component disorders.

“With the positive impact of the intervention evident in stable hemodialysis patients, as indicated by stable or improved post-intervention test results without significant fluctuations, it is clear that this intervention could effectively address electrolyte and blood component disorders.”

Probably not a substantial claim: may not pass S2 (checkable).

This study provides new evidence on the effectiveness of nursing interventions in the management of chronic kidney disease patients on hemodialysis.

“This study provides new evidence on the effectiveness of nursing interventions in the management of CKD patients on hemodialysis.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Dehydration can elevate the body's creatinine concentration.

“Dehydration can elevate the body's creatinine concentration.26”

• cites [26] Brazilian Society of Nephrology Biomarkers in Nephrology Accessed 5 June 2023 https://arquivos.sbn.org.br/pdf/biomarcadores.pdfNot checked yet

  Not checked in the free run.

May combine two claims.

For URR, patients in the intervention group had the same average dialysis quality, while those in the control group were close to the 65% cut-off, indicating a deterioration in hemodialysis adequacy.

“For URR, the patients in IG had the same average dialysis quality, while those in CG were close to the 65% cut-off, indicating a deterioration in hemodialysis adequacy.”

May combine two claims.

The statistically significant results indicated significant improvements in laboratory tests, dialysis adequacy and patient care process.

“The statistically significant results indicated significant improvements in laboratory tests, dialysis adequacy and patient care process.”

May combine two claims.

This not only improves patients' quality of life, but also reduces the risk of complications related to electrolyte imbalances and dialysis inadequacy.

“This not only improves patients' quality of life, but also reduces the risk of complications related to electrolyte imbalances and dialysis inadequacy.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

This proactive, evidence-based approach by nurses plays a key role in promoting effective care for chronic kidney disease patients with excess fluid volume, inadequate fluid control and electrolyte disturbances, as well as improving dialysis adequacy.

“This proactive, evidence-based approach by nurses plays a key role in promoting effective care for CKD patients with excess fluid volume, inadequate fluid control and electrolyte disturbances, as well as improving dialysis adequacy.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Applying this intervention not only improves test results, but also improves patient quality of life while reducing the risk of adverse events related to fluid and electrolyte imbalances in this population.

“Applying this intervention not only improves test results, but also improves patient quality of life while reducing the risk of adverse events related to fluid and electrolyte imbalances in this population.”