Overhydration measured by bioimpedance analysis and the survival of patients on maintenance hemodialysis: a single-center study

Kim, Ye Jin; Jeon, Hyeon‐Gu; Kim, Yoo Hyung; Jeon, Jae Wan; Ham, Young Rok; Chung, Sarah; Choi, Dae Eun; Na, Ki Young; Lee, Kang Wook

doi:10.1016/j.krcp.2015.10.006

Cited by 61 publications

(87 citation statements)

References 37 publications

(39 reference statements)

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“…They concluded that anemia might have contributed to the increase of overall mortality, though the Odds ratio was not increased to a statistically significant degree. Anemia may be a secondary effect by overhydration rather than malnutrition or decrease in red blood cells (24). In our study there was significant anemia in the mortality group.…”

Section: Discussionsupporting

confidence: 40%

The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients

Hür¹,

Budak²,

Mağden³

et al. 2017

Turk Neph Dial Transpl

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OBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD). Our aim was to investigate the long-term effects of hypervolemia and malnutrition evaluated by bioimpedance spectroscopy (BIS) on survival. (Clinical Trials. Gov Identifier: NCT01468363). MATERIAL and METHODS:A total of 431 Prevalent HD patients were followed for 32.2±14.4 months. The patients underwent BIS measurement, a medical history was obtained, and routine tests were analyzed at the baseline and at the end of the study. Hospitalizations and complications of HD were recorded. RESULTS:The mean age was 59.4±14.6 (10-92) years with a total of 431 (53.6% males) patients of which 125 died. The percentage of diabetics was 47%, erythropoietin use 67%, and diuretic use 40%. Predialysis systolic blood pressure (BP) was 133.4±25.8 and diastolic BP 79.2±12.4 mm Hg.The rate of diabetes, and the number of hospitalizations and blood transfusions were higher in the patients who died. Diastolic BP as a clinical hypervolemia finding, BIS hypervolemia indicator of over hydration (OH), and extracellular water (ECW) were all increased, and fat tissue index as a malnutrition finding was decreased in patients who died. There were significant rates of anemia and hypoalbuminemia in this group as well.The cumulative survival was lower in hypervolemic patients as assessed by relative hydration status OH/ECW. CONCLUSION:Hypervolemia and malnutrition are the long-term mortality indicators in hemodialysis. Early diagnosis and treatment is important. Clinical findings may not be sufficient and laboratory and BIS methods can be used for diagnosis. Ölen hastaların diyabet oranı, hastaneye yatışları ve kan transfüzyon sayıları daha fazla idi. Ölen hastalarda: klinik hipervolemi bulgularından diyastolik kan basıncı, BİS hipervolemi göstergesi olan aşırıhidrasyon (OH), Hücredışı su (ECW), artmış, malnütrisyon bulgusu olarak yağ kitle endeksi azalmıştı. Bu grupta anlamlı anemi ve hipoalbuminemi mevcuttu.

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Section: Discussionsupporting

confidence: 40%

The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients

Hür¹,

Budak²,

Mağden³

et al. 2017

Turk Neph Dial Transpl

View full text Add to dashboard Cite

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“…Extracellular fluid (ECF) excess is a common condition in patients with advanced CKD and undergoing dialysis, and previous studies have shown that ECF excess is associated with all‐cause mortality and cardiovascular morbidity 5, 6. Although there is abundant evidence that ECF status is associated with adverse clinical outcomes in patients undergoing dialysis, only a few studies have evaluated the association of fluid excess with cardiovascular risk factors or adverse cardiovascular outcomes in patients with CKD.…”

Section: Introductionmentioning

confidence: 99%

Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

Park

Jhee

Yun

et al. 2018

JAHA

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BackgroundExtracellular fluid (ECF) excess is an independent predictor of cardiovascular morbidity in patients undergoing dialysis. This study aimed to investigate the relationship between ECF status, which is affected by renal function, and coronary artery calcification (CAC), which is a marker of cardiovascular disease, in patients with chronic kidney disease (CKD).Methods and ResultsA total of 1741 patients at all stages of pre‐dialysis CKD from the prospective observational cohort of CMERC‐HI (Cardiovascular and Metabolic Disease Etiology Research Center‐High Risk) were analyzed for the association between ECF status and CAC. ECF status was defined as extracellular water‐to‐total body water ratio (ECW/TBW) measured using bioelectrical impedance analysis. ECF excess was defined as ECW/TBW ≥0.390 or ≥0.400 depending on its severity. To define CAC, Agatston coronary artery calcium scores were measured. A total coronary artery calcium score of ≥400 was defined as CAC. The CKD stages were defined according to estimated glomerular filtration rate calculated using the CKD Epidemiology Collaboration equation. ECW/TBW and the proportion of ECF excess increased with progressing CKD stages. Multivariable logistic regression analyses showed that ECW/TBW was independently associated with CAC (per 0.01 increase of ECW/TBW, odds ratio 1.168, 95% confidence interval, 1.079–1.264, P<0.001). The adjusted R 2 for predicting higher coronary artery calcium scores and CAC significantly improved after ECW/TBW was added to conventional factors. This association was further confirmed by net reclassification and integrated discriminant improvements, sensitivity analysis, and subgroup analysis.Conclusions ECF status is independently associated with a high risk of CAC in patients with CKD.Study Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02003781.

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“…48 Dialysis centres are now increasingly using measurement devices based on bioimpedance technology, as they are non-invasive, simple and inexpensive. 27,49,50 Description of technology(ies) under assessment Summary of the multiple-frequency bioimpedance devices under assessment Bioimpedance technology involves assessment of fat-free mass and total body water in people without significant fluid and electrolyte abnormalities. 51 Extracellular water (ECW) and intracellular water (ICW) contains ions and, therefore, conducts, so its volume measurement is based on its resistance, or impedance, as cell membranes may act as capacitors at low or intermediate frequencies.…”

Section: Measurement Of Diseasementioning

confidence: 99%

“…The InBody S10 is a portable device that uses a direct multiple-frequency bioimpedance analysis method to provide measurements across six different frequencies (1,5,50,250, 500 and 1000 kHz). Measurements of five segments of the body are available: right arm, left arm, trunk, right leg and left leg.…”

Section: Inbody S10mentioning

confidence: 99%

“…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%

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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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Overhydration measured by bioimpedance analysis and the survival of patients on maintenance hemodialysis: a single-center study

Cited by 61 publications

References 37 publications

The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients

The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients

Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

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

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