Hemodialysis Centers Research Articles

Study of Relationship between Heparin and Platelets in Hemodialysis Patients

Platelets are considered one of the most important components of blood that contribute to the coagulation process, and they also play an important role in the blood clotting process. Platelets may be exposed to some types of anticoagulant drugs, such as heparin, which increases the risk of thrombocytopenia, especially in dialysis patients who receive heparin periodically in the extracorporeal circuit in the dialysis unit; thrombocytopenia may develop due to receiving heparin in every dialysis session, which has been confirmed for patients in previous research. This research, aims to find the relationship between heparin and platelets among dialysis patients. Some parameters were carried on for hemodialysis patients of (Al-Jamil - Raqdalin - Zuwara) hemodialysis centers to support the study of the relationship between them, (CBC, PT, PTT, CT, and BT), also a questionnaire has been collected from the patients for further information. The results showed that there is an inverse relationship between the dose of heparin and platelets at α (0.5), meaning that the higher the dose of heparin, the greater the thrombocytopenia. We also found that there is an inverse relationship between the duration of dialysis and platelets, meaning that the longer the duration of dialysis, the lower the platelet count. The results showed also the presence of clots in the dialysis machine in varying proportions. We can conclude that there are no effects on the types of treatment doses on the platelets. Also, heparin dose and Platelets count have an inverse significant relationship. We can conclude also that there are no significant differences between the average platelets due to the types of heparin at the level of significance.

Handgrip strength is independently associated with physical quality of life in patients undergoing maintenance hemodialysis: a cross-sectional study.

We aimed to identify the association between Health-related quality of life (HRQoL) and muscle strength in patients undergoing maintenance hemodialysis (MHD). In this cross-sectional study from March 2021 to December 2021, 110 MHD patients with a mean age of 63.9 ± 13.0 years and a median dialysis vintage of 25.5 (12.0-52.3) months, were enrolled at a hemodialysis center in Guangzhou city, China. HRQoL was assessed using the Short Form 36 Health Survey (SF-36) and converted into the Physical Component Summary (PCS) and the Mental Component Summary (MCS). The groups were assigned according to the mean score of PCS and MCS, and those with higher PCS/MCS scores (high-PCS/MCS) were compared with those with lower PCS/MCS scores (low-PCS/MCS). Independent factors were evaluated using multivariate analysis. Muscle strength was estimated by handgrip strength (HGS). The mean HGS was 23.7 ± 9.60 kg in men and 14.3 ± 5.30 kg in women. Compared to the high-PCS group, the low-PCS group had older age, higher levels of creatinine, total cholesterol, high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6), and had lower HGS (all p < 0.05). After adjusting for confounding factors in different models, the five-model multivariate binary logistic regression analyses revealed that HGS was the only independent factor in PCS domain, but not in MCS. HGS may be an independent factor of poor HRQoL in MHD patients, particularly in relation to physical health. The management of muscle strength may improve the HRQoL in MHD patients. The study was registered at https://www.chictr.org.cn/ as ChiCTR2100053790.

The Association of β2-Microglobulin with Physical Performance in Chinese Hemodialysis Patients with and without Diabetes.

Higher β2-Microglobulin (β2-MG) is associated with aging, stroke and cognitive impairment, which are all connected with poor physical fitness. Poor physical function is ascribed to increasing mortality. However, there has been an academic dispute over the association of serum β2-MG with survival rate. Furthermore, diabetes mellitus (DM) has been well linked to poor physical function and a high level of β2-MG. We hypothesized that higher β2-MG could be associated with worse physical performance in hemodialysis (HD) patients, and that association could vary with diabetes. We conducted a multicenter cross-sectional study at seven HD centers in Shanghai and Suzhou, respectively, in China, where a collection was made of the clinical characteristics, laboratory indicator, physical performance and DM assessment. The physical function was measured by the Short Physical Performance Battery (SPPB), and SPPB score ≤9 as the cutoff for low physical performance.The patients were divided into two groups of low and high physical performance, before categorized into four subgroups based on the absence of diabetes and SPPB scores. Logistic regression analyses were conducted to explore the association of β2-MG with physical performance. The final analysis involved a total of 780 patients, 251(32.2%) having diabetes. In the total population, β2-MG was lower in those with low SPPB than in those with high SPPB. Only in non-diabetic patients, β2-MG was lower in the low SPPB group, and positively associated with SPPB and its three compenents scores. Regardless of diabetes status, those who had low SPPB were prone to be older, accompanied by the poor nutritional status. Addtionally, the diabetes patients tended to have shorter HD duration and higher body mass index than the non-diabetic patients. Both before and after the covariates adjusted, β2-MG was significantly associated with physical performance in HD patients without diabetes. Low level of β2-MG was significantly associated with poor physical performance in Chinese HD patients without DM.

Cross-culture adaptation and validation of Indonesian language version of Pittsburgh Sleep Quality Index

Hemodialysis (HD) patients have a high rate of poor sleep. The Pittsburgh Sleep Quality Index (PSQI) is the most popular self-reported instrument to measure sleep quality. No study has tested the psychometric efficiency of the Bahasa (Indonesian language) PSQI in hemodialysis (HD) patients, and no cross-cultural adaptation has been done. The purpose of this research was to translate the PSQI into Bahasa and improve its psychometric properties for use in evaluating HD patients in Indonesia. This study used instrument translation, cultural adaptation, content validation, and equivalence to crossculturally validate and adapt an instrument. The hemodialysis center at a West Java medical facility served as a source of potential HD patients throughout the period of October 2022 to February 2023. A content validity index (CVI) was calculated for each item and the entire scale. The factor structure of the Bahasa PSQI has been evaluated by confirmatory factor analysis and internal consistency was calculated using Cronbach's alpha. The online survey received a response rate of 62.8% from a total of 220 patient with HD (about ten responders each item). The level of language clarity was 87.8%, and the level of cultural relevance was 84.5%. The CVI varied from 0.92 to 1.00. Each factor had factor loading ranging from 0.51 to 0.62. that Cronbach alpha for total score was 0.803, and the subscale ranged from 0.771 to 0.863. Our research provides preliminary evidence of the validity and reliability of the translated and adapted tool using data from HD patients in Indonesian hospitals.

Establishment of a nomogram that predicts the risk of heart failure in hemodialysis patients

Chronic kidney disease (CKD) is expected to become the fifth leading cause of death globally by 2040. Cardiovascular disease (CVD), particularly heart failure (HF), is a severe complication in CKD patients on hemodialysis. This study aimed to develop a nomogram to predict the risk of heart failure hospitalization in hemodialysis patients, providing a valuable tool for clinical decision-making. We retrospectively analyzed data from 196 patients at Kunming Yanan Hospital's hemodialysis center, including demographic, dialysis-related, and laboratory information. Significant HF predictors identified through univariate and multivariate logistic regression were age, diabetes, dialysis duration, left ventricular mass index (LVMI), albumin (ALB), and ejection fraction (EF). These predictors formed the basis of the nomogram, which demonstrated good discrimination (AUC = 0.728) and calibration (Hosmer-Lemeshow test, P = 0.463). Decision curve analysis confirmed the nomogram's clinical utility across various threshold probabilities. This study's findings can help clinicians identify high-risk patients, improving management strategies and potentially reducing HF-related hospitalizations in the hemodialysis population.

Pre-infection liver function is associated with all-cause mortality among hemodialysis patients with SARS-CoV-2 Omicron variant infection

Background There is ample evidence to suggest that patients infected with SARS-CoV-2 Omicron variant may experience liver dysfunction. However, the impact of pre-infection liver function on postinfection mortality rates remains inadequately researched. Methods Data from 847 hemodialysis (HD) patients, diagnosed with Omicron across six HD centers between December 2022 and February 2023, were analyzed. Initial liver function assessments were conducted, following which patients were monitored for mortality outcomes. The stepwise multivariable Cox regression analysis and receiver operating characteristic (ROC) curves were utilized to identify the predictors of mortality. Results From the total, 98 patients (11.6%) succumbed, with a majority (80/98) within a month postinfection. The deceased patients were observed to be mostly older males with an increased prevalence of diabetes and tumors, signifying higher AST and C-reactive protein levels. These patients also exhibited lower hemoglobin, albumin, and prealbumin levels. An elevated AST [per 1 IU increment; HR 1.04 (95% CI 1–1.04), p = 0.026], AST/ALT ratio [per 1 increment; HR 1.52 (95% CI 1.27–2.36), p = 0.004], and reduced prealbumin [per 10 mg/L increment; HR 0.93 (95% CI 0.9–0.96), p < 0.001] were discovered to be independent indicators of an increased mortality risk. Notably, AST, AST/ALT ratio, and prealbumin proved significant predictors of mortality (AUC values were 0.59, 0.65, and 0.79 respectively). Conclusions This study underscores that pre-infection liver function, specifically AST, AST/ALT ratio, and prealbumin levels, substantially influence the mortality rates in HD patients following Omicron infection. Therefore, careful consideration of these liver function parameters could guide superior patient management strategies and potentially decrease mortality rates within this at-risk population.

Hemodialysis Experience After Kahramanmaraş Earthquake.

Background: Hemodialysis treatment for acute kidney injury associated with crush syndrome is very complex. In our study, we summarized the problems and complications experienced by our hemodialysis center after the Kahramanmaraş earthquake. Methods: After the earthquake, our hospital treated 1396 victims. We evaluated the initial indications for dialysis, hemodialysis complications and the mortality of patients undergoing hemodialysis, including crush-related acute kidney injury (n = 82), during the earthquake period. We also compared them with patients who were undergoing hemodialysis (n = 76) in the same period but had end-stage renal failure and acute kidney injury due to other causes (n = 15). Results: After the earthquake, 173 adult patients, 91 (52.6%) of whom were male, with a mean age of 49.5 + 19.7 years, underwent hemodialysis between 6 and 22 February 2023. Patients with crush-related acute kidney injury experienced more complications during hemodialysis, and the increase in creatine kinase activity increased the risk of hemodialysis complications. The most common complications were blood clots in the dialyzer membrane, intradialytic hypotension, and intradialytic insufficient flow. The most frequent indication for initial hemodialysis was hyperkalemia (61, 74.4%). The major problems in the hemodialysis center included inadequate equipment and an insufficient number of experienced health personnel. Conclusions: Hyperkalemia is the most important initial indication for hemodialysis in patients with crush-related acute kidney injury. Crush-related acute kidney injury patients require hemodialysis more frequently, and hemodialysis complications are higher in patients with crush-related AKI, so the hemodialysis treatment of these patients should be more cautious. In an earthquake, hemodialysis centers may face significant challenges, such as damage, transportation issues, power outages, and water outages, which can hinder hemodialysis treatment.

Effect of virtual reality video application on fistula puncture-associated pain in patients undergoing hemodialysis: Assessor-blinded randomized trial.

To elucidate the effect of virtual reality video application on fistula puncture-associated pain in patients undergoing hemodialysis. Attention controlled and assessor-blinded randomized trial. Attention controlled and assessor-blinded randomized trial was conducted 28 patients at the hemodialysis center of City Hospital. The patients in the intervention group (n = 14) participated in 12 hemodialysis sessions with virtual reality video application under the researcher's supervision. The patients in the control group (n = 14) received a 6-min training session on diet compliance. The Sociodemographic Form and Visual Analog Scale were used to collect data in person at various time points: baseline (t0), during the 1st to 12th hemodialysis sessions (t1-t12), and 1 week after implementation (t13). Virtual reality video application helped in effectively decreasing pain over time, as revealed by significant differences in the measurements at t1-t12 and t13 (p < 0.05). Time-based variations in within-group differences revealed that the median fistula puncture-associated pain values were significantly higher at baseline and t13 measurements in the intervention group (p < 0.05). In contrast, no significant differences were observed in the median fistula puncture-associated pain values in the control group (p < 0.05). In patients undergoing hemodialysis, the application of virtual reality helps decrease fistula puncture-associated pain values. Advances in technology, particularly virtual reality, may play a vital role in shaping the future of healthcare.

COVID-19-induced extracorporeal circulation coagulation during continuous renal replacement therapy: A cross-sectional study.

After the control policies of the COVID-19 epidemic were lifted in China from December 5th, 2022, there was an increase in the demand for hemodialysis and continuous renal replacement therapy (CRRT) at our center, and patients experienced hypercoagulable blood states more frequently. This study aimed to investigate the effect of COVID-19 on extracorporeal coagulation during CRRT. All CRRT records were gathered from the Hemodialysis Center at our hospital from December 5th, 2022 to February 4th, 2023, and analyzed the incidence and risk factors associated with extracorporeal coagulation. COVID-19 substantially increased the likelihood of extracorporeal coagulation during CRRT. Venous pressure and transmembrane pressure were proportional to the severity of extracorporeal coagulation. Additionally, non-tunnel type conduit vascular access, and acute kidney injury had a positive correlation with the severity of coagulation. Blood tests demonstrated that COVID-19 altered 4 coagulation indices. Moreover, mitigation of coagulation can be achieved through increasing the dosage of low molecular weight heparin and administering regional citrate anticoagulation. Patients who fail anticoagulation may be switched to peritoneal dialysis. In conclusion, COVID-19 poses a heightened risk of extracorporeal coagulation during CRRT. This study underscores the importance of anticoagulant treatment in CRRT for infected patients with kidney failure and holds significant implications for clinical practice. In future, the epidemics of COVID-19 or any other pandemic, the metrics in this study can be referenced to determine coagulation risk, as well as relevant therapeutic practices may be considered.

Bioelectrical impedance analysis–derived phase angle predicts possible Sarcopenia in patients on maintenance hemodialysis: a retrospective study

BackgroundThe prevalence of possible sarcopenia is notably high among maintenance hemodialysis (MHD) patients. Possible sarcopenia, defined as a decrease in muscle strength and/or somatic function, is an early and reversible condition between non-sarcopenic and sarcopenia, and early recognition and intervention for possible sarcopenia is important for preventing adverse outcomes and improving the quality of life of these patients. This study aimed to establish a simple and effective model for screening and identifying MHD patients at high risk of possible sarcopenia by using 50 kHz-Whole Body Phase Angle (PhA), with a specific focus on gender differences.MethodsThis prospective cross-sectional study was conducted from September to December 2023 at the Wenjiang Hemodialysis Center in the Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China. A total of 244 MHD patients, including 130 males and 114 females, were enrolled. Data were collected prospectively, including demographic information and physical measurements. All participants provided informed consent before enrollment. Measurements were taken post-dialysis to ensure consistency. The whole-body phase angle was measured using the InBody S10 device, grip strength was measured using an electronic grip strength tester, and physical function was assessed by the Short Physical Performance Battery (SPPB). The Skeletal Muscle Index (SMI) was also calculated.ResultsA total of 244 patients receiving hemodialysis were enrolled in this study. Among these, 109 patients were categorized as non-sarcopenic, 111 as having possible sarcopenia, and 24 as sarcopenic. The prevalence of sarcopenia among MHD patients is 9.8%, while the prevalence of possible sarcopenia is 45.5%. The receiver operating characteristic (ROC) curve analysis showed that for male patients, the AUC of PhA for predicting possible sarcopenia was 0.798, with a sensitivity of 80.36%, specificity of 69.70%, and a cutoff value of 6.20°. For female patients, the AUC of PhA was 0.701, with a sensitivity of 70.91% and specificity of 62.79%, and a cutoff value of 5.70°.ConclusionsPhA may be a useful and simple predictor of the risk of possible sarcopenia in MHD patients, and more research is needed to further promote the use of PhA in possible sarcopenia.

Associated Factors of Viral Hepatitis Transmission among Hemodialysis Adult Patients

Background: Individuals suffering from chronic kidney disease (CKD) are more likely to die, particularly those with end-stage kidney disease. Surprisingly, these deaths are related to many diseases, and this mortality rate motivates us to identify additional risk factors that can be modified to improve survival in patients requiring hemodialysis. Hepatitis virus infection has been associated with many comorbidities other than the liver, such as kidney disease, cardiovascular disease, insulin resistance, diabetes mellitus, and lymphoproliferative disease. Objective: To estimate the hepatitis prevalence in hemodialysis units and assess the risk factors contributing to viral hepatitis infection in hemodialysis centers. Materials and Methods: Cohort study design conducted in dialysis centers-Najaf AL Ashraf\ Iraq , , May 2023. The sample was collected by questionnaire and by referring to patient records to measure the prevalence of viral hepatitis. Results: 72 patients with hepatitis in hemodialysis centers responded to study. Their ages ranged from 20-78 years. The group of participants (41-60 years old) constituted approximately half of sample, and the percentage of sex was males more than females. The prevalence of viral hepatitis was 10.3 %. Among patients with hemodialysis treatment, hepatitis B virus is less than C.

Quality of life and social reinsertion of patients on maintenance haemodialysis in four government funded hospitals in Cameroon.

Reduced quality of life is associated with shorter survival in chronic illnesses. However, the health-related quality of life (HRQOL) and social reinsertion of patients on maintenance haemodialysis is much more underappreciated in resource-limited countries such as Cameroon. A hospital-based cross-sectional study was carried out from February 22nd to May 20th, 2022, in 4 government-funded haemodialysis centres in three randomly selected regions of Cameroon. Patients received twice-weekly dialysis sessions. Social reinsertion and HRQOL were assessed using a structured questionnaire and the kidney disease quality of life instrument (KDQOL-36™). HRQOL scores < 50 were categorized as low, while scores > 50 reflected better HRQOL. Data were analysed using the software statistical package for Social Sciences version 25.0. Statistical significance was set at a p value < 0.05. The study included 434 patients. The mean age was 48.33 (13.55) years, 65.7% (285/434) were male, 62.3% (269/434) had no monthly income, and the mean dialysis vintage was 3.74 (3.83) years. The mean HRQOL score was 44.34 (9.77), and 76.2% (325/434) had HRQOL scores < 50). Overall HRQOL was associated with older age (aOR: 2.344, CI 1.089-5.04). After the initiation of maintenance haemodialysis, 67.1% (49/73) of students dropped out of school. The main reason for school absenteeism and unemployment was physical insufficiency, with 82.4% (19/24) and 52.4% (75/144), respectively. There were no promotions or marriages after initiation; 51% (221/434) of relationships with relatives and friends were affected negatively, while 83.3% (66/79) of those of marriageable ages could not find suitors. The social participation score was poor in 61.5% (267/434) of participants. There was an association between low QOL and social participation (p = 0.009). The HRQOL of patients on maintenance haemodialysis is greatly reduced, especially their physical health status. Older age was a determinant of low QOL. Additionally, social reinsertion remains poor due to adverse changes that occur to these patients and their families after dialysis initiation. Not applicable.

Acute Kidney Injury by Near-drowning: From the Beach to the Hemodialysis Center: A Case Report

Acute Kidney Injury by Near-drowning: From the Beach to the Hemodialysis Center: A Case Report

Implementing a multisite shared haemodialysis care programme.

Adults receiving centre-based haemodialysis (HD) have low levels of patient activation which are associated with poorer outcomes. Shared haemodialysis care (SHC) describes an intervention whereby individuals are supported to undertake elements of their treatment to improve their activation levels and promote better self-care. This project aimed to increase the proportion of those performing SHC in seven HD centres within the Oxford Kidney Unit's catchment area. Sequential Plan-Do-Study-Act (PDSA) cycles effected change first in two central HD centres, in cycles 1 and 2, before rolling out to five satellite HD centres, in cycles 3 and 4. Cycle 1 explored and transformed staff perceptions regarding SHC using a questionnaire and teaching sessions while in cycle 2, staff partnered with patients to develop leaflets and noticeboards to improve awareness and participation. These interventions were then rolled out to the remaining HD centres in PDSA cycles 3 and 4. Other interventions included: Enrolling staff and patients in virtual training courses; designating SHC 'Champions'; engagement with a national SHC forum; and changes to the electronic patient record to enable the monitoring of patient SHC opportunity and to promote sustainable change. Outcome measurement data on the number of patients performing SHC and the number at different defined stages of SHC competency were captured monthly. In April 2022, only 4% (19/483) of those receiving centre-based HD performed any aspect of SHC. By the end of the project in December 2023, this had increased to 43% (220/511). There was a significant and sustained growth in the stage of patient SHC competency as well as the number of patients performing SHC in each HD centre. The project demonstrated that it is possible to implement, scale-up and maintain a multisite SHC programme even with little baseline staff and patient SHC experience.

Falls in Hemodialysis Centers

Falls in Hemodialysis Centers

Estimation of Staphylococcus total viable count in different contamination states of central venous catheters in hemodialysis centers based on tunable diode laser wavelength‐modulation spectroscopy

AbstractThe surveillance and assessment of the total viable count (TVC) of Staphylococcus under different levels of catheter contamination are crucial for the prevention and evaluation of catheter‐related infections in hemodialysis (HD). This paper demonstrates the noninvasive and accurate measurement of the TVC of Staphylococcus using wavelength‐modulated tunable diode laser absorption spectroscopy (WMAS). The tunable distributed feedback laser with a central wavelength of 2004 nm was employed and the detection limit of 22.5 ppm for carbon dioxide (CO2) produced by Staphylococcus epidermidis was obtained. The growth of Staphylococcus under different medium concentrations was studied, and the results indicated a strong correlation between the growth rate and final TVC of S. epidermidis with the medium concentration. When the degree of catheter contamination was low, resulting in minimal residual nutrient concentration within the catheter, the bacterial growth rate and TVC were effectively suppressed. Therefore, it is proven that WMAS is a user‐friendly, noninvasive, and high signal‐to‐noise ratio technique for monitoring Staphylococcus, making it an effective tool for assessing Staphylococcus growth in HD catheter surveillance.

Impact of Hemodialysis Center Accreditation on Patient Mortality: Korean Nationwide Cohort Study

Impact of Hemodialysis Center Accreditation on Patient Mortality: Korean Nationwide Cohort Study

Outcomes of Patients with Nonkidney Medical Therapies Dialyzed at Chronic Hemodialysis Centers

Outcomes of Patients with Nonkidney Medical Therapies Dialyzed at Chronic Hemodialysis Centers

Audit from a Hemodialysis Facility in a small town in Punjab

Patients with advanced Chronic Kidney Disease ultimately require Renal Replacement Therapy. In the absence of widespread availability of renal transplant, dialytic therapies remain the last court of appeal for most of the patients with CKD V. Hemodialysis remains the most common form of dialytic therapy utilized by the patients. Since the governmental support for dialysis has increased in the recent years, now the therapy is also available in smaller cities and towns. This is commendable since it reduces the financial burden of patients associated with travelling to larger cities twice a week to receive dialysis therapy. These centers in smaller towns have their own profile of problems to deal with. Here we present our data collected from hemodialysis centre in a small city of Pakistan.

Cost-effectiveness of bioimpedance-guided fluid management in patients undergoing haemodialysis: the BISTRO RCT.

The BioImpedance Spectroscopy to maintain Renal Output randomised controlled trial investigated the effect of bioimpedance spectroscopy added to a standardised fluid management protocol on the risk of anuria and preservation of residual kidney function (primary trial outcomes) in incident haemodialysis patients. Despite the economic burden of kidney disease, the cost-effectiveness of using bioimpedance measurements to guide fluid management in haemodialysis is not known. To assess the cost-effectiveness of bioimpedance-guided fluid management against current fluid management without bioimpedance. Within-trial economic evaluation (cost-utility analysis) carried out alongside the open-label, multicentre BioImpedance Spectroscopy to maintain Renal Output randomised controlled trial. Thirty-four United Kingdom outpatient haemodialysis centres, both main and satellite units, and their associated inpatient hospitals. Four hundred and thirty-nine adult haemodialysis patients with > 500 ml urine/day or residual glomerular filtration rate > 3 ml/minute/1.73 m2. The study intervention was the incorporation of bioimpedance technology-derived information about body composition into the clinical assessment of fluid status in patients with residual kidney function undergoing haemodialysis. Bioimpedance measurements were used in conjunction with usual clinical judgement to set a target weight that would avoid excessive fluid depletion at the end of a dialysis session. The primary outcome measure of the BioImpedance Spectroscopy to maintain Renal Output economic evaluation was incremental cost per additional quality-adjusted life-year gained over 24 months following randomisation. In the main (base-case) analysis, this was calculated from the perspective of the National Health Service and Personal Social Services. Sensitivity analyses explored the impact of different scenarios, sources of resource use data and value sets. The bioimpedance-guided fluid management group was associated with £382 lower average cost per patient (95% CI -£3319 to £2556) and 0.043 more quality-adjusted life-years (95% CI -0.019 to 0.105) compared with the current fluid management group, with neither values being statistically significant. The probability of bioimpedance-guided fluid management being cost-effective was 76% and 83% at commonly cited willingness-to-pay threshold of £20,000 and £30,000 per quality-adjusted life-year gained, respectively. The results remained robust to a series of sensitivity analyses. The missing data level was high for some resource use categories collected through case report forms, due to COVID-19 disruptions and a significant dropout rate in the informing BioImpedance Spectroscopy to maintain Renal Output trial. Compared with current fluid management, bioimpedance-guided fluid management produced a marginal reduction in costs and a small improvement in quality-adjusted life-years. Results from both the base-case and sensitivity analyses suggested that use of bioimpedance is likely to be cost-effective. Future work exploring the association between primary outcomes and longer-term survival would be useful. Should an important link be established, and relevant evidence becomes available, it would be informative to determine whether and how this might affect longer-term costs and benefits associated with bioimpedance-guided fluid management. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number HTA 14/216/01 (NIHR136142).