Does Routine Bioimpedance-Guided Fluid Management Provide Additional Benefit to Non-Anuric Peritoneal Dialysis Patients? Results from Compass Clinical Trial

Oh, Kook‐Hwan; Baek, Seon Ha; Joo, Kwon-Wook; Kim, Yon Su; Kim, Sejoong; Oh, Yun Kyu; Han, Byoung Geun; Chang, Jae Hyun; Chung, Wookyung; Na, Ki Young

doi:10.3747/pdi.2016.00241

Cited by 37 publications

(31 citation statements)

References 28 publications

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“…However, these findings suggest that the cardiac structure or function of both groups improved during the study. Our results are partially in agreement with those of previous randomized controlled studies on non‐anuric PD patients who underwent BIS‐guided fluid or clinical method‐guided management: those studies showed that the BIS did not provide better volume control than the clinical method. We speculate that the clinical judgment alone was sufficient to achieve euvolemia because the patients had RKF.…”

Section: Discussionmentioning

confidence: 99%

“…This suggests that BIS‐guided volume control may also be useful for PD patients, particularly because hypervolemia is a frequent finding in these patients: several studies show that about 50% of PD patients are overhydrated . However, there is controversy regarding the clinical usefulness of BIS‐guided fluid management in PD patients and the data are limited …”

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confidence: 99%

“…11,12 However, there is controversy regarding the clinical usefulness of BIS-guided fluid management in PD patients and the data are limited. 13,14 To resolve this issue, we conducted a randomized controlled trial to evaluate the effect of BIS-guided fluid management on RKF preservation, volume control and cardiovascular (CV) events in non-anuric PD patients.…”

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confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…In contrast to the above, in the COMPASS study, a multicenter RCT with 137 Korean PD patients with urine output >500 mL, BIS-guided fluid management did not result in longer RRF preservation (ΔGFR: −1.5 ± 2.4 vs. −1.3 ± 2.6 mL/min/1.73 m 2 , p = 0.593), the study’s primary outcome, nor in better volume control (relative OH > 15%: 21.9 vs. 21.5% p = 0.165) or significant differences in SBP levels (130.8 ± 19.7 vs. 137.1 ± 23.7 mm Hg, p = 0.104), in LV mass index (103 ± 29 vs. 105 ± 28 g/m 2 , p = 0.609) or in heart-femoral PWV (1,017 ± 286 vs. 989 ± 274 cm/s, p = 0.63) compared to conventional clinical assessment after 12 months. 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].…”

Section: Bia Techniquesmentioning

confidence: 99%

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

2020

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Background: The majority of patients undergoing peritoneal dialysis (PD) suffer from volume overload and this overhydration is associated with increased mortality. Thus, optimal assessment of volume status in PD is an issue of paramount importance. Patient symptoms and physical signs are often unreliable indexes of true hydration status. Summary: Over the past decades, a quest for a valid, reproducible, and easily applicable technique to assess hydration status is taking place. Among existing techniques, inferior vena cava diameter measurements with echocardiography and natriuretic peptides such as brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were not extensively examined in PD populations; while having certain advantages, their interpretation are complicated by the underlying cardiac status and are not widely available. Bioelectrical impedance analysis (BIA) techniques are the most studied tool assessing volume overload in PD. Volume overload assessed with BIA has been associated with technique failure and increased mortality in observational studies, but the results of randomized trials on the value of BIA-based strategies to improve volume-related outcomes are contradictory. Lung ultrasound (US) is a recent technique with the ability to identify volume excess in the critical lung area. Preliminary evidence in PD showed that B-lines from lung US correlate with echocardiographic parameters but not with BIA measurements. This review presents the methods currently used to assess fluid status in PD patients and discusses existing data on their validity, applicability, limitations, and associations with intermediate and hard outcomes in this population. Key Message: No method has proved its value as an intervening tool affecting cardiovascular events, technique, and overall survival in PD patients. As BIA and lung US estimate fluid overload in different compartments of the body, they can be complementary tools for volume status assessment.

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“…In nephrology, the benefit of using the Body Composition Monitor (BCM) to evaluate 'normohydration weight' 10,11 has been recognized for hemodialysis patients [12][13][14] , as well as for peritoneal dialysis (PD) patients 15 . Prospective studies aiming at improving hard outcomes in PD patients using BCM-BIS are ongoing 16,17 and have recently been completed 18 .…”

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confidence: 99%

Bioimpedance spectroscopy for fluid status assessment in patients with decompensated liver cirrhosis: Implications for peritoneal dialysis

Schwaiger

Simon

Wabel

et al. 2020

Sci Rep

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Bioimpedance spectroscopy (BIS) is routinely used in peritoneal dialysis patients and might aid fluid status assessment in patients with liver cirrhosis, but the effect of ascites volume removal on BISreadings is unknown. Here we determined changes in BIS-derived parameters and clinical signs of fluid overload from before to after abdominal paracentesis. Per our pre-specified sample size calculation, we studied 31 cirrhotic patients, analyzing demographics, labs and clinical parameters along with BIS results. Mean volume of the abdominal paracentesis was 7.8 ± 2.6 L. From pre-to post-paracentesis, extracellular volume (ECV) decreased (20.2 ± 5.2 L to 19.0 ± 4.8 L), total body volume decreased (39.8 ± 9.8 L to 37.8 ± 8.5 L) and adipose tissue mass decreased (38.4 ± 16.0 kg to 29.9 ± 12.9 kg; all p < 0.002). Correlation of BIS-derived parameters from pre to post-paracentesis ranged from R² = 0.26 for body cell mass to R² = 0.99 for ECV. Edema did not correlate with BIS-derived fluid overload (fo ≥ 15% ECV), which occurred in 16 patients (51.6%). In conclusion, BIS-derived information on fluid status did not coincide with clinical judgement. The changes in adipose tissue mass support the BIS-model assumption that fluid in the peritoneal cavity is not detectable, suggesting that ascites (or peritoneal dialysis fluid) mass should be subtracted from adipose tissue if BIS is used in patients with a full peritoneal cavity.Liver cirrhosis impairs both the splanchnic and the systemic circulation resulting in a "hyperdynamic circulatory syndrome" 1-3 . Portal hypertension causes vasodilation in the splanchnic circulation, and thereby ascites and hepatorenal syndrome 1,4 . Adaption mechanisms to portal hypertension in the systemic circulation can lead to decreased systemic vascular resistance, decreased arterial blood pressure and increased cardiac output and heart rate, potentially triggering cardiomyopathy 1,2,4-6 . Optimizing fluid volume therefore is crucial in treating patients with liver cirrhosis.The clinical evaluation of the fluid status of patients with liver cirrhosis is challenging. Intravascular volume depletion can coexist with edema and ascites, so that the application of diuretics aimed at diminishing edema or ascites can lead to additional intravascular volume depletion and kidney injury. Application of parenteral fluid can potentially worsen ascites, pleural effusion or heart failure 7-9 .

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Does Routine Bioimpedance-Guided Fluid Management Provide Additional Benefit to Non-Anuric Peritoneal Dialysis Patients? Results from Compass Clinical Trial

Cited by 37 publications

References 28 publications

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

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

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

Bioimpedance spectroscopy for fluid status assessment in patients with decompensated liver cirrhosis: Implications for peritoneal dialysis

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