Abstract:Introduction and Aims: Hypertension in chronic hemodialysis (HD) patients ( pts) is volume dependent on up to 80% of cases. Volume assessment by bioimpedance spectroscopy (BIS) could be more accurate and better target for the treatment then just clinically assessed dry weight (DW). The studies have shown that the relative overhydration (ROH) of HD pts above 15% of their total body extracellular water (ECW), poses increased mortality risk in this population. The concept of the Active Fluid Management (AFM) has … Show more
“…The search process is depicted in Figure 1. Table 118, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 shows the characteristics of the studies, including 10 trials investigating the measurement of bioimpedance,19, 20, 21, 22, 23, 24, 26, 27, 28, 29 1 trial investigating the use of blood volume monitoring, 18 and 1 trial investigating the combined use of lung ultrasound and bioimpedance 25 . No eligible randomized control trials investigated the use of inferior vena cava ultrasound, natriuretic peptides, or chest radiograph.…”
Section: Resultsmentioning
confidence: 99%
“…No eligible randomized control trials investigated the use of inferior vena cava ultrasound, natriuretic peptides, or chest radiograph. Five studies comprised only peritoneal dialysis patients,19, 23, 27, 28, 29 whereas 7 were conducted among maintenance hemodialysis patients 18, 20, 21, 22, 24, 25, 30. The median intervention period was 12 months, with 2 studies21, 25 having a follow-up period of more than 12 months.Figure 1Flow diagram of included studies.…”
Section: Resultsmentioning
confidence: 99%
“…Increase of target weight when clinical symptoms develop if absolute fluid overload <1.1 literComposite: all-cause mortality or first cardiovascular event24 moAcademicPaunic et al. 201826, 30 (not registered)Hemodialysis patients8357 ± 121 center, SerbiaBioimpedance using BCM (Fresenius medical care) every mo and frequency increased to every wk if OH > 15% or symptomsTarget weight was adjusted according to bioimpedance findings and clinical judgment. Changes of target weight of 0.1 to 0.5 kg/wk to obtain average weekly relative OH ≤15%Change in echocardiographic parametersArterial blood pressure9 moIndustryOh et al.…”
“…The inadequate description of random sequence generation19, 22, 23, 27, 30 and/or allocation concealment19, 20, 21, 22, 24, 25, 27, 30 was a further concern in several trials. Finally, 1 study was considered to be at very high risk of bias as it was stopped prematurely at half of the planned follow-up duration for unclear reasons 19 .…”
IntroductionTechnological adjuncts have been developed to improve the accuracy of fluid removal goals in maintenance dialysis recipients. We aimed to determine whether the introduction of these tools has been shown to impact clinical outcomes.MethodsWe performed a systematic review and meta-analysis of randomized controlled trials that compared fluid management guided by technological adjuncts to standard care in hemodialysis and peritoneal dialysis. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular events, hospitalizations, intradialytic hypotension, blood pressure, symptoms, antihypertensive medications. and left ventricular mass index.ResultsOf the 2940 citations retrieved, we identified a total of 12 eligible trials comprising 2406 participants. In the 10 studies (n = 2111) with data on mortality, the use of adjunct technologies was not associated with a reduction of mortality (rate ratio [RR]: 0.92; confidence interval [CI]: 0.57–1.51; I2 = 36%). The intervention conferred a reduction in systolic arterial pressure (mean difference: −3.14; CI: −5.89 to −0.38; I2 = 39%) but did not affect other outcomes. In a subgroup analysis, bioimpedance was associated with a reduced risk of hospitalization (RR: 0.68; CI: 0.46–0.99; I2 = 55%). The risk of bias was high or unclear in most studies and the quality of evidence was judged to be low.ConclusionsAmong maintenance dialysis recipients, technological adjuncts for fluid management did not improve survival. Trials mostly investigated the use of bioimpedance, whereas the evidence for use of other technologies remain very scarce. Future adequately powered trials should assess a broader array of promising technologies using meaningful clinical outcomes over a prolonged follow-up duration.
“…The search process is depicted in Figure 1. Table 118, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 shows the characteristics of the studies, including 10 trials investigating the measurement of bioimpedance,19, 20, 21, 22, 23, 24, 26, 27, 28, 29 1 trial investigating the use of blood volume monitoring, 18 and 1 trial investigating the combined use of lung ultrasound and bioimpedance 25 . No eligible randomized control trials investigated the use of inferior vena cava ultrasound, natriuretic peptides, or chest radiograph.…”
Section: Resultsmentioning
confidence: 99%
“…No eligible randomized control trials investigated the use of inferior vena cava ultrasound, natriuretic peptides, or chest radiograph. Five studies comprised only peritoneal dialysis patients,19, 23, 27, 28, 29 whereas 7 were conducted among maintenance hemodialysis patients 18, 20, 21, 22, 24, 25, 30. The median intervention period was 12 months, with 2 studies21, 25 having a follow-up period of more than 12 months.Figure 1Flow diagram of included studies.…”
Section: Resultsmentioning
confidence: 99%
“…Increase of target weight when clinical symptoms develop if absolute fluid overload <1.1 literComposite: all-cause mortality or first cardiovascular event24 moAcademicPaunic et al. 201826, 30 (not registered)Hemodialysis patients8357 ± 121 center, SerbiaBioimpedance using BCM (Fresenius medical care) every mo and frequency increased to every wk if OH > 15% or symptomsTarget weight was adjusted according to bioimpedance findings and clinical judgment. Changes of target weight of 0.1 to 0.5 kg/wk to obtain average weekly relative OH ≤15%Change in echocardiographic parametersArterial blood pressure9 moIndustryOh et al.…”
“…The inadequate description of random sequence generation19, 22, 23, 27, 30 and/or allocation concealment19, 20, 21, 22, 24, 25, 27, 30 was a further concern in several trials. Finally, 1 study was considered to be at very high risk of bias as it was stopped prematurely at half of the planned follow-up duration for unclear reasons 19 .…”
IntroductionTechnological adjuncts have been developed to improve the accuracy of fluid removal goals in maintenance dialysis recipients. We aimed to determine whether the introduction of these tools has been shown to impact clinical outcomes.MethodsWe performed a systematic review and meta-analysis of randomized controlled trials that compared fluid management guided by technological adjuncts to standard care in hemodialysis and peritoneal dialysis. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular events, hospitalizations, intradialytic hypotension, blood pressure, symptoms, antihypertensive medications. and left ventricular mass index.ResultsOf the 2940 citations retrieved, we identified a total of 12 eligible trials comprising 2406 participants. In the 10 studies (n = 2111) with data on mortality, the use of adjunct technologies was not associated with a reduction of mortality (rate ratio [RR]: 0.92; confidence interval [CI]: 0.57–1.51; I2 = 36%). The intervention conferred a reduction in systolic arterial pressure (mean difference: −3.14; CI: −5.89 to −0.38; I2 = 39%) but did not affect other outcomes. In a subgroup analysis, bioimpedance was associated with a reduced risk of hospitalization (RR: 0.68; CI: 0.46–0.99; I2 = 55%). The risk of bias was high or unclear in most studies and the quality of evidence was judged to be low.ConclusionsAmong maintenance dialysis recipients, technological adjuncts for fluid management did not improve survival. Trials mostly investigated the use of bioimpedance, whereas the evidence for use of other technologies remain very scarce. Future adequately powered trials should assess a broader array of promising technologies using meaningful clinical outcomes over a prolonged follow-up duration.
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