Authors: (including presenting author): :
Tam SL (1), Sung D(2), Chan K(4), Chan HY(1), Ho J(1), Wu J(1), Chan W(3), Man J (3),Lee PY(2), Wong FKY(4), Chak WL (2), Mak SK(1), Wong PN(1), Lo J(1)
Affiliation: :
(1) Department of Medicine and Geriatrics, Kwong Wah Hospital (2) Department of Medicine, Queen Elizabeth Hospital, Hospital Authority (3) Occupational Therapy Department, Kwong Wah Hospital (4) School of Nursing, The Hong Kong Polytechnic University
Keyword 1: :
end-stage kidney disease (ESKD)
Keyword 2: :
intraperitoneal pressure (IPP)
Keyword 3: :
Continuous Ambulatory Peritoneal Dialysis (CAPD)
Keyword 4: :
Nocturnal Intermittent Peritoneal Dialysis (NIPD)
Keyword 6: :
Ultrafiltration (UF)
Introduction: :
Elevated intraperitoneal pressure (IPP) affects ultrafiltration and increases risks in peritoneal dialysis (PD) for end-stage kidney disease (ESKD) patients. Standardized IPP measurement is crucial.
Objectives: :
This study aimed to develop and validate the “Hydro-Ruler”, a novel device to standardize IPP measurement in adult PD patients using an interprofessional approach to enhance accuracy and replace traditional visual estimation.
Methodology: :
This study used a comparative reliability and validity design in two Hong Kong regional hospital renal units to evaluate the “Hydro-Ruler,”. An interprofessional team engineered the device with integrated bubble levels for precise zero-referencing. The approach adopted a 2-phases approach: initially, 14 nurses achieved 92.3% agreement on a competency checklist across 14 patients to ensure standardization. Subsequently, these trained nurses conducted simultaneous measurements comparing the Hydro-Ruler against traditional methods. Evaluation focused on inter-rater reliability, validity, and accuracy in measuring IPP (range: 5–15 cmH₂O). This process ensured staff alignment before rigorously validating the device’s performance against existing clinical standards.
Result & Outcome: :
A total of 30 patients were recruited across two sites (KWH: n = 24; QEH: n = 6). Intraclass Correlation Coefficient (ICC) estimates and their 95% confidence intervals were calculated using SPSS version 26. ICC ( 0.75 to 0.9: good reliability). Inter-rater reliability was assessed using a Two-way Mixed Effects Model (Absolute Agreement). The ICC values represent the agreement between Rater 1 and Rater 2 for the average of 6 trials. Results show both raters had excellent agreement on the readings on two methods, but higher in the Hydro-Ruler Method. Intra-rater reliability was assessed using a One-way Random Effects Model (Consistency) to determine the stability of the 6 repeated measurements taken by each rater. There is no significant difference between raters.
Conclusions:
The Hydro-Ruler demonstrated a slightly higher inter-rater reliability compared to the traditional method and is a reliable device to measure IPP.
