Abstract: PO0856
Clinical Outcomes of Bioimpedance Analysis-Guided Hemodialysis: A Meta-Analysis of Randomized Controlled Trials
Session Information
- Fluid, Electrolytes, and Clinical Events with Dialysis: Getting to the "Heart" of the Matter
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Hansrivijit, Panupong, UPMC Pinnacle, Harrisburg, Pennsylvania, United States
- Qian, Chenchen, UPMC Pinnacle, Harrisburg, Pennsylvania, United States
- Mohan, Sumit, Columbia University Irving Medical Center, New York, New York, United States
Background
Determination of fluid status in hemodialysis patients could be a great challenge for providers. Body composition monitoring using bioimedance analysis (BIA) is an emerging tool in guiding fluid removal in hemodialysis population. However, although there are some randomized controlled trials (RCT), the reported outcomes remain heterogenous and inconclusive across studies.
Methods
Ovid MEDLINE, EMBASE and the Cochrane Library were searched for eligible articles through May 2021. Inclusion criteria were: 1) RCT comparing BIA against clinical assessment, 2) sample size > 50, 3) adults > 18 years on hemodialysis (HD), 4) clinical outcomes were reported. No publication bias detected by Egger’s regression intercept analysis.
Results
A total of seven RCTs (n = 1029 total; 519 BIA, 510 control), dated from 2010 to 2019, with a mean follow-up duration of 15.0±10.6 months were identified. There was no difference in mortality between BIA and clinical group (odds ratio [OR] 0.797; 95% CI 0.431, 1.472; I2 13.2%). BIA group had significantly lower weight change during follow-up duration compared to clinical group (standard means difference [SMD] -0.270; 95% CI -0.532, -0.008; I2 9.6%). Clinical group had significantly higher systolic blood pressure compared to BIA group (SMD 0.157; 95% CI 0.034, 0.280; I2 2.3%) with a mean difference of 3.052 mmHg (95% CI 0.851, 5.253; I2 0%). Clinical group had significantly higher pulse wave velocity compared to BIA group (SMD 0.795; 95% CI 0.545, 1.045; I2 0%). Clinical group had significantly higher pre-HD body weight (SMD 0.280; 95% CI 0.130, 0.430; I2 48.1%) with a mean difference of 0.370 kg (95% CI 0.178, 0.563; I2 47.8%) compared to BIA group. There was no difference in post-HD body weight between the two groups (SMD 0.156; 95% CI -0.055, -0.366; I2 0%).
Conclusion
There was no mortality benefit to BIA-guided HD compared with clinical-guided HD. However, BIA-guided HD improved systolic blood pressure and weight gain compared to clinical-guided HD. Pulse wave velocity, which represents arterial stiffness, was also lower in BIA group. Although our findings suggest some non-mortality benefits to BIA-guided HD, however, the clinical impact of BIA-guided HD on cardiovascular events, intradialytic complications, and patients' quality of life remain to be elucidated in future RCTs.