Body composition monitoring-derived urea distribution volume in children on chronic hemodialysis

Zaloszyc, Ariane; Fischbach, Michel; Betti, Silvia; Uhlmann, Lorenz; Salomon, Rémi; Krid, Saoussen; Schmitt, Claus Peter

doi:10.1007/s00467-015-3283-3

Cited by 4 publications

(5 citation statements)

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“…Ionic dialysance (K OCM ), reflecting urea and small solute clearance, is ordinarily used to quantify dialysis efficiency from periodic measurements (every 30 minutes) and to provide an integrated dialysis performance (K OCM ) throughout the complete dialysis session 28 . Overall ionic clearance (K OCM ) is then used as a surrogate of effective urea clearance both in hemodialysis and ol‐HDF expressed either in total clearance over the session (K OCM times treatment time ( t d ) in L/session) or in fractional clearance (K OCM t d /V) where V (urea volume or total body water) is referring to an anthropometric value derived from the Watson formula 27,29‐31 …”

Section: Discussionmentioning

confidence: 99%

“…28 Overall ionic clearance (K OCM ) is then used as a surrogate of effective urea clearance both in hemodialysis and ol-HDF expressed either in total clearance over the session (K OCM times treatment time (t d ) in L/session) or in fractional clearance (K OCM t d /V) where V (urea volume or total body water) is referring to an anthropometric value derived from the Watson formula. 27,[29][30][31] The originality of our work was to develop a simple sodium Flux model relying on K OCM values to compute ionic (sodium equivalent) dialysance, and then to estimate the net sodium mass removal using plasma and dialysate sodium concentrations estimated from conductivity measurements. Ionic mass balance has been proposed by different authors to guide dialysate sodium prescription to implement isonatremic dialysis or to prevent sodium patient load.…”

Section: Discussionmentioning

confidence: 99%

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Quantitative assessment of sodium mass removal using ionic dialysance and sodium gradient as a proxy tool: Comparison of high‐flux hemodialysis versus online hemodiafiltration

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Quantitative assessment of sodium mass removal using ionic dialysance and sodium gradient as a proxy tool: Comparison of high‐flux hemodialysis versus online hemodiafiltration

et al. 2021

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“…24,59 The evidence of association between BCM assessment and improved patient outcomes is mixed. The Canadian Agency for Drugs and Technologies in Health (CADTH)'s rapid-response report, published in 2015, 53 identified two randomised controlled trials (RCTs) of 131 and 189 participants, respectively 60,61 and one observational study of 110 participants, which assessed the use of the BCM in people receiving HD.…”

Section: Body Composition Monitormentioning

confidence: 99%

“…24,[72][73][74] Appendix 2 presents the characteristics of these studies. In the list of non-randomised studies that were not deemed suitable for inclusion based on the above criteria, no UK-based studies, studies that included any of the specified devices (other than the BCM) or studies reporting relevant outcomes not otherwise described in the report were identified.…”

Section: Assessment Of Clinical Effectivenessmentioning

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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Dialyse

Schmitt¹

2017

Nierenerkrankungen Im Kindes- Und Jugendalter

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Body composition monitoring-derived urea distribution volume in children on chronic hemodialysis

Cited by 4 publications

References 49 publications

Quantitative assessment of sodium mass removal using ionic dialysance and sodium gradient as a proxy tool: Comparison of high‐flux hemodialysis versus online hemodiafiltration

Quantitative assessment of sodium mass removal using ionic dialysance and sodium gradient as a proxy tool: Comparison of high‐flux hemodialysis versus online hemodiafiltration

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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