Non-Pharmacological Nursing Management of Edema in Acute Kidney Injury: A Case Study of Ankle Pump Exercises and 30° Leg Elevation
DOI:
https://doi.org/10.53713/htechj.v4i4.450Keywords:
Acute Kidney Injury, Ankle Pump Exercise, Edema, 30° Leg ElevationAbstract
Acute Kidney Injury (AKI) frequently induces sodium retention and hypoalbuminemia, precipitating severe peripheral edema that threatens cardiopulmonary and neurological stability. Non-pharmacological interventions are increasingly sought to safely and effectively manage this complex fluid overload in clinical settings. This case study aimed to evaluate the clinical efficacy of a combined nursing intervention, specifically structured ankle pump exercises and 30-degree leg elevation, in mitigating peripheral edema severity in an adult patient with AKI. A descriptive, single-subject case study design was employed within a regional hospital ward setting. The intervention was administered twice daily over a consecutive five-day period. Edema severity was quantitatively assessed at baseline and post-intervention utilizing a standardized pitting edema observation sheet to measure precise tissue depth and rebound time. The intervention yielded clinically meaningful improvements by the third day of implementation. Bilateral lower extremity edema successfully decreased from Grade III to Grade II, accompanied by a measurable reduction in pitting depth and improved tissue recoil time. These objective findings demonstrate enhanced venous return and successful mobilization of interstitial fluid. Ankle pump exercises combined with 30-degree leg elevation represent a highly viable, cost-effective, and independent nursing strategy for managing peripheral edema in AKI patients. This non-pharmacological approach safely complements standard medical management, empowering patient self-care while circumventing the iatrogenic risks associated with aggressive pharmacological diuresis.
References
Abe, M., Hemmi, S., & Kobayashi, H. (2023). How should we treat acute kidney injury caused by renal congestion? Kidney Research and Clinical Practice, 42(4), 415. https://doi.org/10.23876/j.krcp.22.224
Argaiz, E. R., Rola, P., Haycock, K. H., & Verbrugge, F. H. (2022). Fluid management in acute kidney injury: From evaluating fluid responsiveness towards assessment of fluid tolerance. European Heart Journal: Acute Cardiovascular Care, 11(10), 786–793. https://doi.org/10.1093/ehjacc/zuac104
Bell, S., Claure-Del Granado, R., Lumlertgul, N., McCulloch, M., Mohamed, A., Pannu, N., Sahay, M., Soranno, D. E., Ostermann, M., Mehta, R., & Menon, S. (2026). The impact of social determinants of health on acute kidney injury. Nature Reviews Nephrology, 22(6), 438–452. https://doi.org/10.1038/s41581-026-01063-3
Cerda, J., Kashani, K., Ostermann, M., Basu, R. K., Bell, S., Cantaluppi, V., Chakaravarthi, R., Costa, J. M., Claure-Del Granado, R., Macedo, E., Rhee, H., Srisawat, N., Wu, V. C., Yang, L., & Mehta, R. L. (2026). The global epidemiology of acute kidney injury: Challenges and opportunities. Nature Reviews Nephrology, 22(3), 179–198. https://doi.org/10.1038/s41581-025-01030-4
Chadwick, S. E. (2022). The use of leg elevation in the treatment of chronic peripheral oedema. British Journal of Community Nursing, 27(Suppl. 10), S28–S32. https://doi.org/10.12968/bjcn.2022.27.Sup10.S28
Chowdhury, G. R., & Kumar, Y. (2023). Non-pharmacological intervention approaches for common symptoms in advanced chronic kidney disease patients on haemodialysis: A narrative review. Indian Journal of Continuing Nursing Education, 24(2), 133–138. https://doi.org/10.4103/ijcn.ijcn_93_22
Dainton, M. (2024). Acute kidney injury. In Renal nursing: Care and management of people with kidney disease (pp. 115–131). Wiley-Blackwell. https://doi.org/10.1002/9781394178797.ch5
Flamm, S. L., Wong, F., Ahn, J., & Kamath, P. S. (2022). AGA Clinical Practice Update on the evaluation and management of acute kidney injury in patients with cirrhosis: Expert review. Clinical Gastroenterology and Hepatology, 20(12), 2707–2716. https://doi.org/10.1016/j.cgh.2022.08.033
Juncos, L. A., Wieruszewski, P. M., & Kashani, K. (2022). Pathophysiology of acute kidney injury in critical illness: A narrative review. Comprehensive Physiology, 12(4), 3767–3780. https://doi.org/10.1002/j.2040-4603.2022.tb00231.x
Kwiatkowska, E., Kwiatkowski, S., Dziedziejko, V., Tomasiewicz, I., & Domański, L. (2023). Renal microcirculation injury as the main cause of ischemic acute kidney injury development. Biology, 12(2), 327. https://doi.org/10.3390/biology12020327
Liu, X., Hu, H., Jin, L., Lin, Q., Liu, P., Li, N., & Chen, Z. (2025). Effect of postoperative ankle pump exercises on the prevention of deep vein thrombosis and venous hemodynamics following lower limb orthopedic surgery: A meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research, 20(1), 863. https://doi.org/10.1186/s13018-025-06236-7
Menon, S., Symons, J. M., & Selewski, D. T. (2023). Acute kidney injury. Pediatrics in Review, 44(5), 265–279. https://doi.org/10.1542/pir.2021-005438
Messina, A., Calatroni, M., Castellani, G., De Rosa, S., Ostermann, M., & Cecconi, M. (2025). Understanding fluid dynamics and renal perfusion in acute kidney injury management. Journal of Clinical Monitoring and Computing, 39(1), 73–83. https://doi.org/10.1007/s10877-024-01209-3
Nei, A. M., Yagnala, N., Thompson, H. A., Hernandez, B. N., & Barreto, E. F. (2025). Acute kidney injury. In The pharmacist's expanded role in critical care medicine: A comprehensive guide for practitioners and trainees (pp. 657–681). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-77335-8_26
Nuraliffa, M., Yeni Yulistanti, Wiwin Renny Rahmawati, & Lulut Handayani. (2026). The effect of combined foot massage and leg elevation on foot edema in third-trimester pregnant women. Health and Technology Journal (HTechJ), 4(1), 8–15. https://doi.org/10.53713/htechj.v4i1.424
Putri, M., Idramsyah, I., & Husni, H. (2025). Application of contrast bath therapy and 30-degree foot elevation to reduce foot edema in patients with congestive heart failure. Journal of Vocational Nursing, 6(1), 19–28. https://doi.org/10.20473/jovin.v6i1.61148
Rancu, A. L., Darby, F. A., Averbukh, L. D., Nicholson, A., Myrick, K. M., Leslie, M. P., & Wiznia, D. H. (2024). Methods to manage edema and reduce flap compression in postoperative nursing care following trauma to the lower extremity. Orthopedic Nursing, 43(6), 325–329. https://doi.org/10.1097/NOR.0000000000001075
Rondhianto, Rohmah, A. I., Mustakim, & Sutawardana, J. H. (2025). Ankle pump exercise and foot massage intervention on reducing leg edema in chronic kidney disease (CKD) patients. Health and Technology Journal (HTechJ), 3(6), 789–796. https://doi.org/10.53713/htechj.v3i6.462
Rroji, M., Kasa, M., Spahia, N., Kuci, S., Ibrahimi, A., & Sula, H. (2024). Kidneys on the frontline: Nephrologists tackling the wilds of acute kidney injury in trauma patients—From pathophysiology to early biomarkers. Diagnostics, 15(19), 2438. https://doi.org/10.3390/diagnostics15192438
Terrades, N. R., Rodríguez Benítez, P., Urbizu Gallardo, J. M., Valdenebro, M., Salgueira, M., Molina Andujar, A., Martins, J., Ramos-Galí, A., Moreno, J. A., De la Cuerda, C., Lloret, M. J., Menéndez, D., Acosta-Ochoa, I., Romero-González, G., & Poch, E. (2025). Consensus document on the diagnosis and treatment of acute kidney injury. Nefrología (English Edition), 46(1), 501360. https://doi.org/10.1016/j.nefroe.2026.501360
Turgut, F., Awad, A. S., & Abdel-Rahman, E. M. (2023). Acute kidney injury: Medical causes and pathogenesis. Journal of Clinical Medicine, 12(1), 375. https://doi.org/10.3390/jcm12010375
Xu, X., Zeng, T., Chen, S., Tian, N., Zhang, C., Chen, Y., ... & Song, Y. (2025). Acute kidney injury: Pathogenesis and therapeutic interventions. Molecular Biomedicine, 6(1), 61. https://doi.org/10.1186/s43556-025-00293-4
Yu, X., Chen, L., Wu, Q., Bi, W., & Yu, S. (2024). Effectiveness of passive ankle pump exercise on lower limb swelling in neonates with a peripherally inserted central catheter: A quasi-experimental study. Revista da Escola de Enfermagem da USP, 58, e20240275. https://doi.org/10.1590/1980-220X-REEUSP-2024-0275en
Zimmerman, P. (2025). Utilizing frailty assessment to impact nursing care for patients with end-stage kidney disease: A quality improvement project. Nephrology Nursing Journal, 52(4). https://doi.org/10.37526/1526-744X.2025.52.4.373
