Value of bioimpedance analysis estimated “dry weight” in maintenance dialysis patients: a systematic review and meta-analysis

Covic, Adrian; Ciumanghel, Adi-Ionut; Siriopol, Dimitrie; Kanbay, Mehmet; Dumea, Raluca; Gavrilovici, Cristina; Nistor, Ionuţ

doi:10.1007/s11255-017-1698-4

Cited by 72 publications

(65 citation statements)

References 27 publications

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“…On the other hand, in an older study, the same group had found that risk prediction for death by assessing fluid status was improved only by using BIA but not by using LUS [76]. Although the majority of the previous observational studies showed a reduction in mortality in ESRD patients, in a recent metaanalysis that included only randomized controlled trials, BIA was not associated with a significant improvement in survival, showing only a better BP control [25].…”

Section: Bioimpedancementioning

confidence: 96%

“…However, as the meta-analysis indicated, such negative results may be explained by the overall small sample size [25]. Although there are few studies comparing other objective methods (BNP [26], Carotid artery Doppler [27]) with classical methods, further studies with larger sample sizes are needed to establish a significant outcome (Table 1) …”

Section: Dry Weightmentioning

confidence: 99%

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Effects of Volume Overload and Current Techniques for the Assessment of Fluid Status in Patients with Renal Disease

et al. 2018

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Volume overload is an important, may be the foremost, independent prognostic factor determining the outcome of hemodialysis patients. Therefore, it is crucial to measure fluid status of these patients and avoid volume overload. This review aims to evaluate volume overload, its effects on patients with renal diseases and current methodologies measuring volume status in the body. These techniques will be first classified as clinical evaluation and non-clinical and/or instrumental techniques, which includes biomarkers, ultrasonography, relative blood volume monitoring, bioimpedance, echocardiography, pulmonary artery catheterization, esophageal and/or suprasternal Doppler, and blood viscosity. Advantages and limitations of these different techniques will be reviewed extensively by comparing each other. At last, insights gained from this review can highlight the future prospects in this active area of research.

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Section: Bioimpedancementioning

confidence: 96%

Section: Dry Weightmentioning

confidence: 99%

Effects of Volume Overload and Current Techniques for the Assessment of Fluid Status in Patients with Renal Disease

et al. 2018

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“…Although one study showed a reduction in mortality with BIS-guided treatment [65], this did not reach significance in 2 subsequent meta-analyses. However, a reduction in pre-dialytic blood pressure was observed with the use of BIS, as well as a reduction in [39,66] FO especially in patients without residual renal function. Enthusiasm for the use of relative BV as a tool for treatment prescription has subsided, since the results of the CLIMB study, which showed that the use of a protocol based on changes in relative BV, was actually associated with an increased mortality.…”

Section: Can Technology Aid the Clinical Decision Process?mentioning

confidence: 99%

Body Fluids in End-Stage Renal Disease: Statics and Dynamics

Kooman

Sande²

2018

Blood Purif

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Background: Abnormalities in fluid status in hemodialysis (HD) patients are highly prevalent and are related to adverse outcomes. Summary: The inherent discontinuity of the HD procedure in combination with an often compromised cardiovascular response is a major contributor to this phenomenon. In addition, systemic inflammation and endothelial dysfunction are related to extracellular fluid overload (FO). Underlying this relation may be factors such as hypoalbuminemia and an increased capillary permeability, leading to an altered fluid distribution between the blood volume (BV) and the interstitial fluid compartments, compromising fluid removal during dialysis. Indeed, whereas estimates of extracellular volume by bioimpedance spectroscopy are highly predictive of mortality, absolute BV assessed by the saline dilution technique was predictive of intra-dialytic morbidity. Changes in relative BV during HD are positively related to ultrafiltration rate (UFR) and, at least in some studies, negatively to FO. High UFR is also related to changes in central venous oxygen saturation (S_cvO₂), a marker for tissue perfusion. On the one hand, high UFR and more pronounced declines in S_cvO₂, but on the other hand, flat relative BV curves are also predictive of mortality; the relation between outcome which statics and dynamics of fluid status appears to be complex. Key Message: While technological developments enable the clinician to monitor statics and dynamics of fluid status and hemodynamics during HD in an accessible way, the role of technology-based interventions needs further study.

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“…Evidence of the impact of BIS‐guided fluid management on survival is still lacking (Covic et al . ) and one limitation of the current adoption of this technology is the use of it in isolation rather than as a part of clinical assessment. It is important to recognise BIS is adding information to an already complex decision‐making process, rather than providing a simple target applicable to all patients (Scotland et al .…”

Section: Introductionmentioning

confidence: 99%

Systematic Fluid Assessment in Haemodialysis: Development and Validation of A Decision Aid

Stenberg

Keane

Lindberg

et al. 2019

Journal of Renal Care

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SUMMARY Background About a third of patients undergoing haemodialysis have poorly controlled fluid status, which may affect survival. Clinical assessment is subjective and imprecise, which has led to the increasing use of devices based on bioimpedance spectroscopy (BIS). However, BIS cannot provide a simple target applicable to all patients. Our aim was to develop and validate a decision aid combining clinical assessment of fluid status with information from BIS in target weight determination. Methods The decision aid was based on empirical experience and a literature review identifying physiological parameters already used in the clinical assessment of fluid status. Content validity was established by patient representatives, interdisciplinary stakeholders and external experts, who assessed item relevance and comprehensiveness. Reliability was assessed by inter‐rater agreement analysis between nurses assessing typical patient cases. Results The decision aid for Recognition and Correction of Volume Alterations (RECOVA) consists of three parts (1) a scoring system; (2) thresholds and triggers; (3) a decision aid algorithm. Agreement between raters in the assessment of symptoms was almost perfect, with Intraclass Correlation Coefficient > 0.90. Agreement in clinical response was only fair, but increased to moderate, with training and self‐reported confidence. Conclusion RECOVA may enable systematic clinical assessment of fluid status, facilitating early recognition of fluid alterations, and incorporation of bioimpedance into target weight management. However, implementation into clinical practice will require training of staff. Clinical intervention studies are required to evaluate if RECOVA facilitates response to and correction of recognised fluid alterations.

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Value of bioimpedance analysis estimated “dry weight” in maintenance dialysis patients: a systematic review and meta-analysis

Cited by 72 publications

References 27 publications

Effects of Volume Overload and Current Techniques for the Assessment of Fluid Status in Patients with Renal Disease

Effects of Volume Overload and Current Techniques for the Assessment of Fluid Status in Patients with Renal Disease

Body Fluids in End-Stage Renal Disease: Statics and Dynamics

Systematic Fluid Assessment in Haemodialysis: Development and Validation of A Decision Aid

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