Patients with terminal or end stage renal disease (ESRD) require lifetime renal replacement therapy. Depending on the medical condition of the patient, local clinical guidelines, and the availability of different therapeutic options, patients can be treated with hemodialysis or peritoneal dialysis modalities. Hemodynamic instability is a challenge that complicates the management of ESRD, and it can present as volume-related hypotension during the dialysis sessions or as hypertension or fluid overload due to insufficient fluid clearance through dialysis. The chronic exposure to fluid overload and hypertension may lead to cardiac stiffness and left ventricular hypertrophy; some studies have reported an increased risk of death due to inadequate total body fluid removal. Therefore, fluid management should be based on accurate estimation of patients’ dialysis needs. These estimates can be obtained clinically by patient examination and the calculation of body dry weight; however, they are subjective and operator-sensitive methods. Objective methods have been developed to provide reliable and accurate estimates of the dry weight and fluid clearance needs; of these are blood volume monitoring, natriuretic peptide measurements, extravascular lung water indices, and bioimpedance methods.
Bioimpedance devices are a technology based on passing a bioelectrical current through the body, and it estimates the body fluid volume by the amount of resistance this current endures in the body tissues. The bioelectrical current used in these devices can have segmental, spectral, or multi-bioelectrical frequencies. Several studies have showed that this method is accurate and reliable for the assessment of body fluids. The objective of this report is to review the evidence on the clinical effectiveness, cost-effectiveness, and evidence-based clinical guidelines on the use of bioimpedance-based fluid management in renal dialysis patients.
Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.
