Abstract
BackgroundLack of accurate and effective assessment tools of fluid status is one of the major challenges to reach proper dry weight (DW) in chronic hemodialysis (HD) population. The aim of this randomized study was to evaluate the effect of bioimpedance guided DW assessment on long-term outcomes in Chinese HD patients. Eligible patients were randomly assigned (1:1) to two groups in each center, the control group and body composition monitor (BCM) group. In the BCM group, DW has been evaluated by bioimpedance technic every 2 months during follow-up. The primary composite endpoint consisted of death, acute myocardial infarction, cerebral infarction, cerebral hemorrhage, and peripheral vascular disease.MethodsA total of 445 patients were recruited from 11 hemodialysis centers from Beijing, Tianjin and Shijiazhuang cities from Jan 1, 2013 to Dec 31, 2014. They were randomized into either BCM group or control group. All patients have been followed up for 1 year or until Dec 31, 2014 or censoring.ResultsAt baseline, there were no significant differences between two groups in terms of demographic parameters, dialysis vintage, percentage of vascular access, and comorbid conditions. At the end of the study, 18 (4.04%) patients had died (11 in control group and 7 in BCM group). Kaplan-Meier survival analysis showed no significant difference in survival rates between two groups (log-rank test P = 0.07). However, there was an increasing trend of survival rates in BCM group compared to the control group. In the multivariable Cox analysis, there was a nonsignificant trend toward less primary composite end points in the BCM group in the adjusted analysis, the hazard ratio was impressive (0.487, 95% CI 0.217–1.091, P = 0.08).ConclusionBioimpedance technic has been applied to assess fluid status for decades and has been proved to be a promising tool for clinical practice. Although short-term outcomes were not improved in the randomized, controlled trial, the ascending trend in survival has been observed. Further studies are needed to investigate the survival benefit of bioimpedance method in DW assessment in a larger sample with longer follow-up period.Trial registrationClinicalTrials.org, NCT01509937. Registered 13 January 2012,
Highlights
Lack of accurate and effective assessment tools of fluid status is one of the major challenges to reach proper dry weight (DW) in chronic hemodialysis (HD) population
Knowledge of optimal fluid status is essential in delivering care to maintenance hemodialysis (MHD) patients
A total of 445 patients were included in the final analysis (Fig. 1): 53.93% males, mean age 54.8 ± 12.7 years, median dialysis vintage of 4.13 years, 91.69% of them were dialyzed through an arterial venous fistula; approximately half of them had ESRD due to chronic glomerulonephritis (51.16%) (Table 1)
Summary
Lack of accurate and effective assessment tools of fluid status is one of the major challenges to reach proper dry weight (DW) in chronic hemodialysis (HD) population. The aim of this randomized study was to evaluate the effect of bioimpedance guided DW assessment on long-term outcomes in Chinese HD patients. Knowledge of optimal fluid status is essential in delivering care to maintenance hemodialysis (MHD) patients. Inferior vena cava diameter measurements, estimations of Nterminal-pro-BNP (N-terminal-pro-brain natriuretic peptide) and other cardiac peptides have not been proved to be practical or reliable in the detection of fluid status in individual patients [15,16,17]. Hypertension alone was found to be unreliable to define hypervolemia in part of some patients [17, 19]
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