Abstract: FR-OR25
Efficacy and Safety of Tool-Guided Dry Weight Adjustment among Dialysis Patients: A Meta-Analysis of Randomized Controlled Trials
Session Information
- Dialysis: What's New in Techniques and Management
October 25, 2024 | Location: Room 8, Convention Center
Abstract Time: 05:30 PM - 05:40 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Wathanavasin, Wannasit, Charoenkrung Pracharuk Hospital, Bangkok, Bangkok, Thailand
- Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Davis, Paul W., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
Recently, various instrumental techniques adjunct to standard clinical evaluation have been used to improve fluid balance and guide dry weight adjustments in dialysis population. We aimed to explore the efficacy and safety of using tool-guided dry weight adjustment among dialysis patients.
Methods
A systematic review was conducted in PubMed, Scopus, and Cochrane Central Register of Controlled trials for relevant RCTs published until April 28, 2024. Studies were selected if they reported at least 1 outcome of interest (e.g. mortality, cardiovascular (CV) events, hospitalization, intradialytic hypotension, hypovolemic events, cardiac arrhythmia or vascular access problems).
Results
A total of 22 RCTs involving 4,310 dialysis patients were analyzed. The meta-analysis revealed that the incorporating tool-guided dry weight adjustment was associated with a significant 21% reduction in CV events (relative risk (RR), 0.79; 95% confidence interval (CI) 0.71 to 0.88), but also resulted in a significant 28% increase in vascular access problems (RR, 1.28; 95% CI, 1.08 to 1.53). In a subgroup analysis, using BIA was associated with a significant reduction in mortality (RR, 0.66; 95% CI 0.50 to 0.86). Additionally, the intervention led to a significant reduction in systolic blood pressure and left ventricular mass index pressure (mean difference, -3.36; 95% CI -5.93 to -0.79 and -0.24; 95% CI -0.48 to 0.00, respectively).
Conclusion
The use of instrumental techniques adjunct to standard clinical evaluation for dry weight adjustment has a positive effect on cardiovascular parameters, including SBP and LVMI, and lowers the risk of CV events in dialysis patients. However, these benefits are accompanied by an increased risk of vascular access problems.