Clinical significance of multi-frequency bioimpedance spectroscopy in peritoneal dialysis patients: independent predictor of patient survival

O’Lone, Emma; Visser, Annemarie; Finney, Hazel; Fan, Stanley

doi:10.1093/ndt/gfu049

Cited by 109 publications

(156 citation statements)

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“…In addition, the ECW:TBW ratio, which is also a predictor of outcome in PD patients, can be influenced by other factors, such as differences in muscle mass or fat tissue mass between patients (30,32). Notably, the relation between the ECW:TBW ratio and the overhydration index which was used both in the present study and in previous cohorts (1,20) is weak (r = 0.31), suggesting that these parameters partly reflect different entities (6). The discussion on the best normalization procedure for mulltifrequency bioimpedance parameters is not fully closed, given the fact that the overhydration index is also influenced by a certain assumption regarding the hydration of lean tissue and fat mass (32,33).…”

Section: Commentariesmentioning

confidence: 59%

Is the Effect of Low-Gdp Solutions on Residual Renal Function Mediated by Fluid State? An Enigmatic Question which Still Needs to be Solved

et al. 2016

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Section: Commentariesmentioning

confidence: 59%

Is the Effect of Low-Gdp Solutions on Residual Renal Function Mediated by Fluid State? An Enigmatic Question which Still Needs to be Solved

et al. 2016

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“…A total of five RCTs (published in six papers 60,61,63,76,77,81 ) and eight non-randomised studies (published in nine papers 30,50,[82][83][84][85][86][87][88] ) were included in the review of clinical effectiveness. There was some question over whether or not the RCTs by Onofriescu et al 81 and Onofriescu et al 60 may be reporting the same trial or outcomes from an overlapping patient population.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…The Onofriescu et al 60 study reports more relevant outcomes and is more recent. Similarly, there is a possibility that the non-randomised studies by O'Lone et al 82 and Oei et al 83 may involve an overlapping patient population, as both studies recruited at the same centre in the same time period. The corresponding authors of both studies were contacted for further clarification, but no replies were received.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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Multiple-frequency bioimpedance devices for fluid management in people with chronic kidney disease receiving dialysis: a systematic review and economic evaluation

Scotland

Cruickshank

Jacobsen

et al. 2018

Health Technol Assess

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BackgroundChronic kidney disease (CKD) is a long-term condition requiring treatment such as conservative management, kidney transplantation or dialysis. To optimise the volume of fluid removed during dialysis (to avoid underhydration or overhydration), people are assigned a ‘target weight’, which is commonly assessed using clinical methods, such as weight gain between dialysis sessions, pre- and post-dialysis blood pressure and patient-reported symptoms. However, these methods are not precise, and measurement devices based on bioimpedance technology are increasingly used in dialysis centres. Current evidence on the role of bioimpedance devices for fluid management in people with CKD receiving dialysis is limited.ObjectivesTo evaluate the clinical effectiveness and cost-effectiveness of multiple-frequency bioimpedance devices versus standard clinical assessment for fluid management in people with CKD receiving dialysis.Data sourcesWe searched major electronic databases [e.g. MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Science Citation Index and Cochrane Central Register of Controlled Trials (CENTRAL)] conference abstracts and ongoing studies. There were no date restrictions. Searches were undertaken between June and October 2016.Review methodsEvidence was considered from randomised controlled trials (RCTs) comparing fluid management by multiple-frequency bioimpedance devices and standard clinical assessment in people receiving dialysis, and non-randomised studies evaluating the use of the devices for fluid management in people receiving dialysis. One reviewer extracted data and assessed the risk of bias of included studies. A second reviewer cross-checked the extracted data. Standard meta-analyses techniques were used to combine results from included studies. A Markov model was developed to assess the cost-effectiveness of the interventions.ResultsFive RCTs (with 904 adult participants) and eight non-randomised studies (with 4915 adult participants) assessing the use of the Body Composition Monitor [(BCM) Fresenius Medical Care, Bad Homburg vor der Höhe, Germany] were included. Both absolute overhydration and relative overhydration were significantly lower in patients evaluated using BCM measurements than for those evaluated using standard clinical methods [weighted mean difference –0.44, 95% confidence interval (CI) –0.72 to –0.15,p = 0.003,I2 = 49%; and weighted mean difference –1.84, 95% CI –3.65 to –0.03;p = 0.05,I2 = 52%, respectively]. Pooled effects of bioimpedance monitoring on systolic blood pressure (SBP) (mean difference –2.46 mmHg, 95% CI –5.07 to 0.15 mmHg;p = 0.06,I2 = 0%), arterial stiffness (mean difference –1.18, 95% CI –3.14 to 0.78;p = 0.24,I2 = 92%) and mortality (hazard ratio = 0.689, 95% CI 0.23 to 2.08;p = 0.51) were not statistically significant. The economic evaluation showed that, when dialysis costs were included in the model, the probability of bioimpedance monitoring being cost-effective ranged from 13% to 26% at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year gained. With dialysis costs excluded, the corresponding probabilities of cost-effectiveness ranged from 61% to 67%.LimitationsLack of evidence on clinically relevant outcomes, children receiving dialysis, and any multifrequency bioimpedance devices, other than the BCM.ConclusionsBCM used in addition to clinical assessment may lower overhydration and potentially improve intermediate outcomes, such as SBP, but effects on mortality have not been demonstrated. If dialysis costs are not considered, the incremental cost-effectiveness ratio falls below £20,000, with modest effects on mortality and/or hospitalisation rates. The current findings are not generalisable to paediatric populations nor across other multifrequency bioimpedance devices.Future workServices that routinely use the BCM should report clinically relevant intermediate and long-term outcomes before and after introduction of the device to extend the current evidence base.Study registrationThis study is registered as PROSPERO CRD42016041785.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Low serum albumin is an adverse risk factor in patients on dialysis, although for each serum albumin category, the adverse risk is higher for patients on HD than patients on PD (23). Although hydration status measured using bioelectric impedance is a predictor of survival in patients on PD (24), no intervention studies have been reported to date that use it to guide clinical decision-making.…”

Section: Evaluation Of Overhydration In Pdmentioning

confidence: 99%

A Patient on Peritoneal Dialysis with Refractory Volume Overload

Wilkie¹

2016

Clinical Journal of the American Society of Nephrology

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The management of volume in patients with diabetes on peritoneal dialysis is affected by several factors, including the degree of residual renal function, peritoneal membrane small-solute transport, salt and water intake, blood sugar control, comorbidity, and nutritional status. It requires sequential evaluation of volume status and adjustment of the peritoneal dialysis prescription on the basis of assessments of membrane function and alterations in urine volume. Steps should be taken to preserve residual renal function for as long as possible. Ultimately, in patients who have become anuric and have developed ultrafiltration failure, timely transfer to hemodialysis may be necessary, requiring discussion and planning with the patient.

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Clinical significance of multi-frequency bioimpedance spectroscopy in peritoneal dialysis patients: independent predictor of patient survival

Cited by 109 publications

References 30 publications

Is the Effect of Low-Gdp Solutions on Residual Renal Function Mediated by Fluid State? An Enigmatic Question which Still Needs to be Solved

Is the Effect of Low-Gdp Solutions on Residual Renal Function Mediated by Fluid State? An Enigmatic Question which Still Needs to be Solved

Multiple-frequency bioimpedance devices for fluid management in people with chronic kidney disease receiving dialysis: a systematic review and economic evaluation

A Patient on Peritoneal Dialysis with Refractory Volume Overload

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