Abstract: PUB091
Use of Bioimpedance Analysis as a Noninvasive Method for Hemodialysis Volume Evaluation: A Case Series
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Bruss, Zachary S., West Los Angeles VA Medical Center, Los Angeles, California, United States
- Siu, Man Kit Michael, West Los Angeles VA Medical Center, Los Angeles, California, United States
- Rastegar, Mandana, West Los Angeles VA Medical Center, Los Angeles, California, United States
- Kraut, Jeffrey A., West Los Angeles VA Medical Center, Los Angeles, California, United States
- Rhee, Connie, West Los Angeles VA Medical Center, Los Angeles, California, United States
Introduction
Fluid status assessment remains one of the most challenging yet critical aspects of managing hemodialysis (HD) patients. Hypervolemia and interdialytic weight gain are independently associated with increased cardiovascular morbidity and mortality. Aggressive ultrafiltration (UF) can be detrimental, leading to intradialytic hypotension and myocardial stunning. Traditional methods for assessing volume status such as physical exam, serum brain natriuretic peptide, and inferior vena cava ultrasound lack sensitivity and specificity. Bioimpedance analysis (BIA) has emerged as a non-invasive modality that measures the body’s resistance to an electrical current to estimate fluid compartments. The ratio of extracellular water to total body water (ECW/TBW) offers a novel tool for dry weight assessment.
Case Description
This case series describes the use of BIA in three HD patients at the West Los Angeles VA Medical Center to guide volume management and reduce hospital admissions. In case 1, a patient with frequent orthostatic hypotension after HD with normal BIA measurements prompted discontinuation of additional dry UF sessions and an upward adjustment in dry weight. In case 2, a patient with recurrent hospitalizations for hypervolemia had HD duration initially increased and later safely reduced after BIA confirmed volume optimization. In case 3, a patient with subclinical volume overload was identified through routine BIA screening, prompting more aggressive UF and dry weight adjustment.
Discussion
Our experience suggests that integrating BIA into dialysis practice can personalize fluid management strategies. The only clinical control trial to date on BIA is the VENUS trial, which supports BIA utility in CRRT. Our case series is limited by sample size and the lack of long-term follow-up. It highlights the need for randomized trials evaluating BIA’s efficacy and clinical utility in the outpatient HD population.