Fp676clinical, Analytical and Bioimpedance Characteristics of Permanently Overhydrated Patients

Castellano, Sandra; Alcala, M. A.; Vázquez, J. Guerrero; Contreras, Juan S.; Cid, Ma Cruz; Ramos, Rosa

doi:10.1093/ndt/gfv182.24

Cited by 6 publications

(17 citation statements)

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“…A total of five RCTs (published in six papers 60,61,63,76,77,81 ) and eight non-randomised studies (published in nine papers 30,50,[82][83][84][85][86][87][88] ) were included in the review of clinical effectiveness. There was some question over whether or not the RCTs by Onofriescu et al 81 and Onofriescu et al 60 may be reporting the same trial or outcomes from an overlapping patient population.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…The eight non-randomised studies were reported in nine full-text papers, 30,50,[82][83][84][85][86][87][88] with the study by O'Lone et al 82 also reported in a secondary study with an additional 51 participants and a 21-month longer follow-up period. 84 The BCM was the multiple-frequency device used in all eight studies.…”

Section: Non-randomised Studiesmentioning

confidence: 99%

“…None of these studies enrolled paediatric populations. Two studies were conducted in the UK, 82,83 two in Seoul, South Korea, 50,85 and one each in Spain, 86 Poland, 87 Romania 88 and Europe. 30 Three studies were multicentred 30,85,86 and the remaining five studies were conducted in single dialysis centres.…”

Section: Non-randomised Studiesmentioning

confidence: 99%

“…Two studies were conducted in the UK, 82,83 two in Seoul, South Korea, 50,85 and one each in Spain, 86 Poland, 87 Romania 88 and Europe. 30 Three studies were multicentred 30,85,86 and the remaining five studies were conducted in single dialysis centres. 50,82,83,87,88 Six studies involved patients receiving HD 30,50,[85][86][87][88] and the remaining two studies involved solely patients treated with PD.…”

Section: Non-randomised Studiesmentioning

confidence: 99%

“…30 Three studies were multicentred 30,85,86 and the remaining five studies were conducted in single dialysis centres. 50,82,83,87,88 Six studies involved patients receiving HD 30,50,[85][86][87][88] and the remaining two studies involved solely patients treated with PD. 82,83 The length of follow-up in the eight non-randomised studies ranged from 16 weeks 85 to 3.5 years.…”

Section: Non-randomised Studiesmentioning

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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Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Section: Non-randomised Studiesmentioning

confidence: 99%

Section: Non-randomised Studiesmentioning

confidence: 99%

Section: Non-randomised Studiesmentioning

confidence: 99%

Section: Non-randomised Studiesmentioning

confidence: 99%

See 3 more Smart Citations

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

View full text Add to dashboard Cite

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Body composition changes and its association with dyslipidemia in patients receiving hemodialysis

Samanta

Bhattacharyya

Panigrahi

et al. 2021

Clinical Epidemiology and Global Health

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The study aimed to assess the body composition changes after dialysis in chronic kidney disease (CKD) patients undergoing hemodialysis and to determine the strengths of relationships between various body composition parameters and blood lipid levels in these patients. Methods: The cross-sectional study was conducted during May-September 2019 involving 97 patients (58 males and 39 females, age: 40-70 years) of CKD undergoing maintenance hemodialysis. The multifrequency bioelectrical impedance analyzer was used to measure various body composition parameters like body fat percent, lean mass percent, body mass index, body fat mass index, fat-free mass index, total body water percent, extracellular water percent, intracellular water percent, nutrition index, prediction marker, basal metabolic rate, and estimated average energy requirement. Blood lipid levels were collected from the patients' clinical records. Results: All the body composition parameters except nutrition index and prediction marker differed significantly before and after dialysis. Various body composition parameters were significantly correlated with one or more lipid levels before and after dialysis. Conclusion:The body composition parameters change significantly after hemodialysis among CKD patients. Our findings suggest that body composition parameters, whether measured before or after dialysis could be useful in assessing dyslipidemia in patients receiving hemodialysis.

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Influence of dry weight reduction on anemia in patients undergoing hemodialysis

et al. 2019

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Objective Volume load in patients undergoing hemodialysis correlates with renal anemia, with reductions in volume load significantly improving hemoglobin levels. We performed a prospective controlled study to assess the effect of post-dialysis dry weight reduction, resulting from the gradual enhancement of ultrafiltration, on renal anemia in this patient population. Methods Sixty-four patients with renal anemia on maintenance hemodialysis were randomized to an ultrafiltration group, in which dry weight was gradually reduced by slightly increasing the ultrafiltration volume while maintaining routine hemodialysis, and a control group, in which patients underwent conventional dialysis while routine ultrafiltration was maintained. After 28 weeks, post-dialysis weight and levels of hematocrit, hemoglobin, C-reactive protein, serum albumin, serum ferritin, and transferrin saturation were compared. Results All parameters were similar at baseline between the two groups and remained unchanged at week 28 in the control group compared with baseline. In contrast, the ultrafiltration group showed a significant reduction in post-dialysis weight and C-reactive protein concentration and a significant increase in hematocrit, hemoglobin, albumin, serum ferritin, and transferrin saturation. Conclusions Dry weight reduction resulting from enhanced ultrafiltration may improve renal anemia in patients undergoing hemodialysis.

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Fp676clinical, Analytical and Bioimpedance Characteristics of Permanently Overhydrated Patients

Cited by 6 publications

References 0 publications

Multiple-frequency bioimpedance devices for fluid management in people with chronic kidney disease receiving dialysis: a systematic review and economic evaluation

Multiple-frequency bioimpedance devices for fluid management in people with chronic kidney disease receiving dialysis: a systematic review and economic evaluation

Body composition changes and its association with dyslipidemia in patients receiving hemodialysis

Influence of dry weight reduction on anemia in patients undergoing hemodialysis

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