Abstract: PUB108
Evaluating Noninvasive Strategies for Volume and Blood Pressure Management in Patients on Hemodialysis: Multiunit Study Using Bioimpedance and Ambulatory BP Monitoring
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Siu, Man Kit Michael, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
- Rastegar, Mandana, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
- Rhee, Connie, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
- Kraut, Jeffrey A., VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
Background
Effective volume and blood pressure (BP) control are essential in managing patients on maintenance hemodialysis (HD). However, distinguishing between normovolemia, chronic fluid overload, and occult hypovolemia remains a persistent clinical challenge. Commonly used tools—such as physical examination, B-type natriuretic peptide (BNP) levels, and inferior vena cava (IVC) ultrasound—often yield incomplete or inconsistent assessments. Emerging technologies, including bioimpedance analysis (BIA) and ambulatory blood pressure monitoring (ABPM), may enhance diagnostic precision by quantifying fluid compartments and capturing interdialytic BP fluctuations, respectively. While several studies have established the standalone utility of ABPM in predicting outcomes and informing hypertension management in HD patients, and the VENUS trial supported BIA-guided volume management in CRRT, no prospective studies have evaluated BIA in the outpatient HD setting. Moreover, the combined use of BIA and ABPM as a complementary strategy to guide HD prescription has yet to be systematically explored.
Methods
This prospective study will be conducted in two VA outpatient HD units: an ambulatory unit (n:39), and a bedbound unit for frail patients (n:36). Charlson Comorbidity Index (CCI) will be assessed. BIA and 24-hour ABPM will be performed every 3–4 months. A rotating schedule (2–3 patients per shift, 2 shifts/day) enables full unit screening. BIA and ABPM data (ECW/TBW ratio, nocturnal BP dipping) will inform UF targets, dialysis frequency, and antihypertensive regimens during multidisciplinary rounds.
Results
Primary outcomes: change in interdialytic weight gain (IDWG), intradialytic hypotension (IDH) frequency, and 6-month all-cause hospitalization. Secondary outcomes: antihypertensive burden, adherence, and KDQOL-36 scores. Exploratory analysis will compare implementation in ambulatory vs. frail cohorts.
Conclusion
This study will evaluate whether integrating BIA and ABPM improves fluid and BP management in outpatient HD and reduces hospital admissions. Results may support broader adoption of these non-invasive tools to guide personalized dialysis prescriptions, particularly in complex or frail patients.