Abstract: SA-PO347
Use of Bioimpedance Techniques in Patients With CKD: A Meta-Analysis
Session Information
- Hemodialysis and Frequent Dialysis: CV and Risk Prediction
November 05, 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
- Horowitz, Laura, McGill University, Montreal, Quebec, Canada
- Karadjian, Oliver Albert, McGill University, Montreal, Quebec, Canada
- Mavrakanas, Thomas, McGill University, Montreal, Quebec, Canada
- Weber, Catherine L., McGill University, Montreal, Quebec, Canada
Background
Bioimpedance technologies are increasingly used to determine extracellular volume status in patients with chronic kidney disease (CKD). We aimed to determine if this technology improves clinical outcomes as compared to usual care.
Methods
We performed a systematic review and meta-analysis of trials comparing fluid management guided by Body-Composition Monitoring or Bioimpedance analysis to standard care in patients with CKD, including patients on dialysis. Our primary outcome was all-cause mortality. Secondary outcomes included blood pressure (BP) control, all-cause hospitalization, major adverse cardiovascular events (MACE), change in left ventricular mass index (LVMi), and residual renal function. The relative risk (RR) or Hedges’ g standardized mean difference (SMD) were estimated using a random-effects model.
Results
Our search identified 819 citations of which 12 randomized-controlled trials (RCTs) and one observational study were included (2670 patients with 1046 on peritoneal dialysis). No studies of non-dialysis dependent CKD patients met inclusion criteria. Mean age was 56 years and mean follow up was one year. There was no difference in all-cause mortality between the bioimpedance and the standard of care arms (RR 0.72, 95% confidence interval [CI] 0.47-1.11). Better diastolic BP control was observed in the bioimpedance arm of RCTs (SMD -0.18, 95% CI -0.34 to -0.02). No difference was observed between the two arms for MACE (RR 0.73, 95% CI 0.49-1.10) or LVMi (SMD -0.17, 95% CI -0.39 to 0.05). All-cause hospitalizations were not significantly different between the two groups (RR 1.08, 95% CI 0.92-1.26). Residual renal function could not be assessed.
Conclusion
Amongst patients on dialysis, bioimpedance-guided volume management showed improved diastolic BP control but no significant difference in all-cause mortality, MACE, and LVMi. Moreover, our study identified a knowledge gap in the use of this technology in non-dialysis dependent CKD patients and the possible effect it may have on clinical outcomes in this population.