Using Bioimpedance Spectroscopy to Assess Volume Status in Dialysis Patients: Results from a Randomized Controlled Trial

Frank M. van der Sande, Esther R. van de Wal-Visscher, Stefano Stuard, Ulrich Moissl, Jeroen P. Kooman*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

16 Citations (Web of Science)

Abstract

The aim of the paper is to reflect on the current status of bioimpedance spectroscopy (BIS) in fluid management in dialysis patients. BIS identifies fluid overload (FO) as a virtual (overhydration) compartment, which is calculated from the difference between the measured extracellular volume and the predicted values based on a fixed hydration of lean and adipose tissue mass. FO is highly prevalent in both hemodialysis (HD) and peritoneal dialysis (PD) patients, while levels of FO are at a population level comparable between PD patients and HD patients when measured before the dialysis treatment. Even mild levels of FO are independently related to outcome in patients on HD, PD as well as in nondialysis patients with advanced chronic kidney disease. FO is not only related to left ventricular hypertrophy (LVH) but also forms part of a multidimensional spectrum with noncardiovascular risk factors such as malnutrition and inflammation. Even after multiple adjustments, FO remains an independent predictor of mortality. BIS-assisted adjustment of dry weight in HD patients has been shown to improve hypertension control and LVH and has resulted in a decline in intradialytic symptomatology. On the other hand, with increased fluid removal, target weight may not always be reached due to an increase in intradialytic symptomatology, and care should be applied in target weight adjustment in fluid overloaded patients with severe malnutrition and/or inflammation. Although a reduction in hospitalization rate was suggested, the effect of BIS-guided dry weight adjustment on mortality has not yet been shown, however, although available studies are underpowered. In PD patients, results have been more equivocal, which may be partly related to differences in treatment protocols or study populations. Future large-scale studies are needed to assess the full potential of BIS.

Original languageEnglish
Pages (from-to)178-184
Number of pages7
JournalBlood Purification
Volume49
Issue number1-2
DOIs
Publication statusPublished - Feb 2020
EventRenal-Research-Institute 22nd International Conference on Dialysis, Advances in Chronic Kidney Disease (CKD) - Los Angeles, United States
Duration: 21 Jan 202024 Jan 2020

Keywords

  • End-stage kidney disease
  • End-stage renal disease
  • Hemodiafiltration
  • Hemodialysis
  • Self-reported sleep duration
  • PERITONEAL-DIALYSIS PATIENTS
  • GUIDED FLUID MANAGEMENT
  • RESIDUAL RENAL-FUNCTION
  • INTERDIALYTIC WEIGHT-GAIN
  • BIOIMPEDANCE SPECTROSCOPY
  • BODY-COMPOSITION
  • MULTIFREQUENCY BIOIMPEDANCE
  • BLOOD-PRESSURE
  • HEMODIALYSIS
  • VOLUME
  • MORTALITY
  • OVERLOAD
  • HYDRATION
  • Outcome
  • Bioimpedance
  • Blood pressure
  • Dialysis
  • Volume control

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