Bioimpedance spectroscopy‐guided fluid management in peritoneal dialysis patients with residual kidney function: A randomized controlled trial

Abstract

Aim Bioimpedance spectroscopy (BIS) allows volume status to be assessed objectively. This study evaluated the effect of BIS‐guided fluid management on residual kidney function (RKF), volume status, and cardiovascular events in peritoneal dialysis (PD) patients. Methods A multicenter, prospective, randomized, controlled trial was conducted over 12 months in 2013–2017. Non‐anuric PD patients (urine volume ≥ 500 mL/day) were randomized to clinical method‐guided management (n = 98) or BIS‐guided management (n = 103). The volume in the BIS group was controlled with BIS, with the aim of achieving the target overhydration (OH) goal of −2.0 to +2.0 L. The volume in the control group was controlled by clinical assessment alone. The groups were compared in terms of change in RKF and volume status at 12 months relative to baseline and in terms of cardiovascular event rates during a median follow‐up period of 36 months. Results Compared with the controls, the BIS group did not show a significant improvement in change in OH, after adjustments were made for covariates (P = 0.191). The two groups did not differ in terms of delta OH, renal creatinine and urea clearance, and 24 h urine volume. The control and BIS groups also did not differ significantly in terms of change in peritoneal ultrafiltration volume, blood pressure, body weight and echocardiographic variables or in cardiovascular event rates (10.2% vs 11.3%; P = 0.953). Conclusion Bioimpedance spectroscopy‐guided fluid management did not show an additional benefit to achieve euvolemia, and did not affect the decline in RKF in non‐anuric PD patients.

Bioimpedance Guided Fluid Management in Peritoneal Dialysis

“…Our previous investigation of the relationship between overhydration and residual kidney function (RKF) demonstrated that overhydration could lead to a decline in RKF per se (30). A recent study from Korea showed that BIA-guided fluid control did not affect RKF of patients on PD (31). In our cohort, the baseline median urine volume was only 250 ml and 88 (36%) patients had anuria.…”

Bioimpedance Indices of Fluid Overload and Cardiorenal Outcomes in Heart Failure and Chronic Kidney Disease: a Systematic Review

“…For example, in dialysis trials, bioimpedance-based assessment of fluid status versus standard clinical assessment improved parameters such as blood pressure, left ventricular mass and arterial stiffness (25,(76)(77)(78). This is yet to be shown to impact upon risk of hard clinical outcomes: randomized trials comparing bioimpedance added to standard care versus standard of care alone have not demonstrated meaningful impact on hospitalizations (32,78), preservation of residual kidney function (79,80), cardiovascular outcomes or death (32,77,78,81,82), but numbers of outcomes in completed trials are generally small (83). Existing national clinical guidelines support the use of bioimpedance devices in dialysis patients when clinical assessment is challenging and suggest further consideration of the role of devices (84, 85) though cost-effectiveness must be considered and has not yet been demonstrated (25).…”

Assessment of Hydration Status in Peritoneal Dialysis Patients: Validity, Prognostic Value, Strengths, and Limitations of Available Techniques

“…Moreover, no added benefit was demonstrated with regard to cardiovascular event-free or anuria event-free survival between the 2 methods (log-rank p 0.161 and 0.933, respectively) [88]. Similarly, results of another Korean RCT showed that BIS-guided fluid management had no effect on RRF, BP levels, echocardiographic parameters, and CV event rates [89]. In another RCT, 308 PD patients were recruited in 4 groups, according to their country of origin (UK or China) and status of RRF (anuric or nonanuric) to account for different therapeutic options available and anthropometric characteristics, as well as the effect of remaining kidney function.…”