Hemodynamic and Biochemical Benefits of the Objective Measurement of Fluid Status in Hemodialysis Patients

Kim, Sejoong; Sung, Jiyoon; Jung, Eui-Chul; Park, Hayne Cho; Lee, Hajeong; Chin, Ho Jun; Kim, Yon Su; Han, Jin Suk; Joo, Kwon Wook

doi:10.1620/tjem.228.125

Cited by 3 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

See 4 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

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.

show abstract

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

show abstract

Maternal pulse pressure at admission is a risk factor for fetal heart rate changes after initial dosing of a labor epidural: a retrospective cohort study

Miller¹,

Cypher²,

Nielsen³

et al. 2013

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

Control of fluid balance guided by body composition monitoring in patients on peritoneal dialysis (COMPASS): study protocol for a randomized controlled trial

Baek

Kim

et al. 2014

Trials

Self Cite

View full text Add to dashboard Cite

BackgroundThe clinical benefits of bioimpedance spectroscopy (BIS)-guided fluid management in patients on hemodialysis have been widely demonstrated. However, no previous reports have evaluated the effect of regular and serial BIS-guided fluid management on the residual renal function (RRF) in patients on peritoneal dialysis (PD). Therefore, we will evaluate the clinical efficacy of BIS-guided fluid management for preserving RRF and protecting cardiovascular events in patients on PD.Methods/designThis is a multicenter, prospective, randomized controlled trial. A total of 138 participants on PD will be enrolled and randomly assigned to receive either BIS-guided fluid management or fluid management based only on the clinical information for 1 year. The primary outcome is the change in the glomerular filtration rate (GFR) between months 0 and 12 after starting treatment. The secondary outcomes will include GFR at month 12, time to the anuric state (urine volume <100 ml/day), and fatal and nonfatal cardiovascular events during treatment.DiscussionThis is the first clinical trial to investigate the effect of BIS-guided fluid management on RRF and for protecting against cardiovascular events in patients on PD.Trial registrationClinical Trials.gov number NCT01887262, June 24, 2013.

show abstract

Hemodynamic and Biochemical Benefits of the Objective Measurement of Fluid Status in Hemodialysis Patients

Cited by 3 publications

References 20 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

Maternal pulse pressure at admission is a risk factor for fetal heart rate changes after initial dosing of a labor epidural: a retrospective cohort study

Control of fluid balance guided by body composition monitoring in patients on peritoneal dialysis (COMPASS): study protocol for a randomized controlled trial

Contact Info

Product

Resources

About