Recognition and Correction of Volume Alterations

Dialysis treatment is life-sustaining and for many an alternative while waiting for a kidney transplant. Individuals with severe kidney failure receiving dialysis have permanent variations in hydration status that may affect their survival; achieving optimal management of fluid status is a key objective in dialysis.

Recova is a decision aid for dialysis care developed by researchers at Uppsala University Hospital, to be able to correctly assess a patient’s fluid balance so that neither too much nor too little fluid is removed during dialysis treatment.

Watch this film to learn more about Recova.

Recova® combines systematic clinical assessment of fluid status with bioimpedance measurement in target weight determination. It consists of three parts: Symptom Scoring, Thresholds and Triggers, and a Decision Aid Algorithm.

Symptom Score thumbnail
Symptom score

Recova® is based on empirical experience and literature review identifying physiological parameters already used in clinical assessment of fluid status. Content validity has been established by patient representatives, interdisciplinary stakeholders and external experts, assessing item relevance and comprehensiveness of the tool. Reliability has been assessed by inter-rater agreement analysis between nurses using Recova® when assessing typical patient cases.

Thresholds and Triggers thumbnail
Thresholds and triggers

By providing a systematic approach to fluid assessment, and guidance in deciding when and how to respond to clinical symptoms, as in the track-and-trigger system, the purpose of Recova® is not only to facilitate recognitions of symptoms of fluid alterations, but also to contribute to improved interdisciplinary communication, and thereby prevent delay of action.

Decision aid thumbnail
Decision aid

Clinical assessment is subjective and imprecise, this has led to increasing use of devices based on bioimpedance spectroscopy (BIS) technology. However, it is important to recognize BIS is adding information to an already complex decision-making process, rather than providing a simple target applicable to all patients. Recova® aims to help clinicians incorporate the information from BIS when setting target weights.

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Download PDF version here.

Download the article "Implementation of a decision aid for recognition and correction of volume alterations (Recova®) in haemodialysis patients", published in Upsala Journal of Medical Sciences 2020

Download the article here.

The Recova® tool has been validated with inter-rater agreement analysis. The study has been published in Journal of Renal Care

Download the article here.


If you are interested in learning more about Recova® please contact Jenny Stenberg at

Jenny Stenberg is a registered nurse and postdoctoral fellow researcher at Uppsala University, Sweden, associated with the renal unit at Uppsala University Hospital.


© 2019-2024 Jenny Stenberg