Bioimpedance Guided Fluid Management in Peritoneal Dialysis

Abstract

Background and objectivesBioelectrical impedance analysis (BIA) devices can help assess volume overload in patients receiving maintenance peritoneal dialysis. However, the effects of BIA on the short-term hard end points of peritoneal dialysis lack consistency. This study aimed to test whether BIA-guided fluid management could improve short-term outcomes in patients on peritoneal dialysis.Design, setting, participants, & measurementsA single-center, open-labeled, randomized, controlled trial was conducted. Patients on prevalent peritoneal dialysis with volume overload were recruited from July 1, 2013 to March 30, 2014 and followed for 1 year in the initial protocol. All participants with volume overload were 1:1 randomized to the BIA-guided arm (BIA and traditional clinical methods) and control arm (only traditional clinical methods). The primary end point was all-cause mortality and secondary end points were cardiovascular disease mortality and technique survival.ResultsA total of 240 patients (mean age, 49 years; men, 51%; diabetic, 21%, 120 per group) were enrolled. After 1-year follow-up, 11(5%) patients died (three in BIA versus eight in control) and 21 patients were permanently transferred to hemodialysis (eight in BIA versus 13 in control). The rate of extracellular water/total body water decline in the BIA group was significantly higher than that in the control group. The 1-year patient survival rates were 96% and 92% in BIA and control groups, respectively. No significant statistical differences were found between patients randomized to the BIA-guided or control arm in terms of patient survival, cardiovascular disease mortality, and technique survival (P>0.05).ConclusionsAlthough BIA-guided fluid management improved the fluid overload status better than the traditional clinical method, no significant effect was found on 1-year patient survival and technique survival in patients on peritoneal dialysis.

Bioelectric impedance analysis for body composition measurement and other potential clinical applications in critical illness

“…BIA is commonly used in dialysis patients to guide fluid management by calculating dry weight goals [ 11 , 44 ]. Likewise, in critical illness PhA, ECW/TBW ratio and overhydration could be used to monitor the effect of fluid management strategies.…”

Peritoneal-Membrane Characteristics and Hypervolemia Management in Peritoneal Dialysis: A Randomized Control Trial

“…The intervention period was relatively short, and some subjects in the study group still had a higher nECW than the target level, and had HTN even though BP improved. Tian et al also reported that BIA assistant intervention does not change a 1-year survival rate in PD [46]; therefore, it is difficult to conclude that BIA assistant dry-weight setting can provide a long-term survival benefit. Lastly, fluid control in the study group was lost in the maintenance phase, which makes the long-term effect of strict dry-weight control on RRF unviable.…”

Body Composition Changes Following Dialysis Initiation and Cardiovascular and Mortality Outcomes in CRIC (Chronic Renal Insufficiency Cohort): A Bioimpedance Analysis Substudy

“… 37 Although a trial of 131 HD patients found improvements in overall survival among patients in the BIA arm at 2.5 years of follow-up, 38 a recent trial that followed up 240 patients receiving PD over 1 year showed no differences in CV events or all-cause mortality. 39 Because these studies were limited by modest sample size (and more importantly, the modest number of events) and focused on prevalent dialysis patients, there is a need for large-scale randomized controlled trials to determine whether optimizing volume status using BIA improves clinical outcomes among patients with CKD initiating maintenance dialysis.…”