Kidney Week

Abstract: FR-PO536

The Bioimpedance Spectroscopy to Preserve Renal Output (BISTRO) Multicentre Randomised Controlled Trial: Quality of Life and Blood Pressure Outcomes

Session Information

• Home Dialysis, Policy, Novel Approaches
  November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Davies, Simon J., Keele University, Keele, Staffordshire, United Kingdom

Simon J. Davies,

• Zanganeh, Mandana, University of Warwick University House, Coventry, West Midlands, United Kingdom

Mandana Zanganeh,

• Solis-Trapala, Ivonne, Keele University, Keele, Staffordshire, United Kingdom

Ivonne Solis-Trapala,

• Keane, David Francis, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, United Kingdom

David Francis Keane,

• Davenport, Andrew, Royal Free London NHS Foundation Trust, London, London, United Kingdom

Andrew Davenport,

• Wilkie, Martin E., Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, United Kingdom

Martin E. Wilkie,

• Ormandy, Paula, University of Salford, Salford, Greater Manchester, United Kingdom

Paula Ormandy,

• Macdonald, Jamie Hugo, Bangor University, Bangor, Gwynedd, United Kingdom

Jamie Hugo Macdonald,

• Dasgupta, Indranil, NHS Birmingham and Solihull Clinical Commissioning Group, Birmingham, Birmingham, United Kingdom

Indranil Dasgupta,

• Farrington, Ken, Hertfordshire Partnership University NHS Foundation Trust, Hatfield, Hertfordshire, United Kingdom

Ken Farrington,

• Caskey, Fergus, University of Bristol, Bristol, Bristol, United Kingdom

Fergus Caskey,

Group or Team Name

• on behalf of the BISTRO Investigators

Background

BISTRO examined if using bioimpedance (BIS) to avoid setting the post-dialysis target weight (PD-TW) below the normally hydrated weight (NHW) could preserve residual kidney function (RKF) when compared to a standardized fluid management protocol. This pre-specified secondary analysis reports the effect of BIS on health-related quality of life, symptoms, and blood pressure.

Methods

BISTRO is an open-label, clinician-blinded, randomized controlled trial in incident HD patients with >500ml urine volume/day or residual GFR >3 ml/min/m². Randomization was by centralized concealed allocation, 1:1, stratified by centre. BIS measurements were taken by independent observers and concealed in the control arm. Secondary outcomes included BP, self-rated health (EQ visual analogue scale), dialysis symptoms, health-related quality of life (EuroQol and Short Form 12), collected at baseline and 3-monthly until month 24. ISCCTN Number: 11342007; Funding: UK NIHR Health Technology Assessment Programme

Results

Questionnaire completeness was 52%–89%, similar by group. Median EQ-VAS rose from 60 to 65 in both groups at 3 months, then back to baseline, remaining stable. Despite a progressive fall in RKF, dialysis symptoms were remarkably stable over 24 months (see Table) with only modest worsening of recovery time, no between-group differences. There was no longitudinal change or between-group difference in BP, just a tendency for a lower post-dialytic BP and more hypotensive symptoms in the control group between 18 and 24 months. Mean difference in PD-TW and NHW was not different between study arm assessments: BIS, n=1335 observations, –0.038Kg (SD 2.7); Control, n=1166 –0.25Kg (2.6)

Conclusion

Using a standardised fluid assessment protocol secondary outcomes were stable in those remaining in the trial and not benefited by the addition of BIS, possibly because clinician fluid assessments were close to the NHW.

Funding

• Government Support – Non-U.S.