title: Effect of fluid management guided by bioimpedance spectroscopy on cardiovascular parameters in hemodialysis patients: a randomized controlled trial.
abstract: BACKGROUND
  Fluid overload is the main determinant of hypertension and left ventricular hypertrophy in hemodialysis patients. However, assessment of fluid overload can be difficult in clinical practice. We investigated whether objective measurement of fluid overload with bioimpedance spectroscopy is helpful in optimizing fluid status.
  
  
  METHODS
  Prospective, randomized, and controlled study.
  
  
  METHODS
  156 hemodialysis patients from 2 centers were randomly assigned to 2 groups.
  
  
  METHODS
  Dry weight was assessed by routine clinical practice and fluid overload was assessed by bioimpedance spectroscopy in both groups. In the intervention group (n = 78), fluid overload information was provided to treating physicians and used to adjust fluid removal during dialysis. In the control group (n = 78), fluid overload information was not provided to treating physicians and fluid removal during dialysis was adjusted according to usual clinical practice.
  
  
  RESULTS
  The primary outcome was regression of left ventricular mass index during a 1-year follow-up. Improvement in blood pressure and left atrial volume were the main secondary outcomes. Changes in arterial stiffness parameters were additional outcomes.
  
  
  METHODS
  Fluid overload was assessed twice monthly in the intervention group and every 3 months in the control group before the mid- or end-week hemodialysis session. Echocardiography, 48-hour ambulatory blood pressure measurement, and pulse wave analysis were performed at baseline and 12 months.
  
  
  RESULTS
  Baseline fluid overload parameters in the intervention and control groups were 1.45 ± 1.11 (SD) and 1.44 ± 1.12 L, respectively (P = 0.7). Time-averaged fluid overload values significantly decreased in the intervention group (mean difference, -0.5 ± 0.8 L), but not in the control group (mean difference, 0.1 ± 1.2 L), and the mean difference between groups was -0.5 L (95% CI, -0.8 to -0.2; P = 0.001). Left ventricular mass index regressed from 131 ± 36 to 116 ± 29 g/m(2) (P < 0.001) in the intervention group, but not in the control group (121 ± 35 to 120 ± 30 g/m(2); P = 0.9); mean difference between groups was -10.2 g/m(2) (95% CI, -19.2 to -1.17 g/m(2); P = 0.04). In addition, values for left atrial volume index, blood pressure, and arterial stiffness parameters decreased in the intervention group, but not in the control group.
  
  
  CONCLUSIONS
  Ambulatory blood pressure data were not available for all patients.
  
  
  CONCLUSIONS
  Assessment of fluid overload with bioimpedance spectroscopy provides better management of fluid status, leading to regression of left ventricular mass index, decrease in blood pressure, and improvement in arterial stiffness.
authors: Division of Nephrology, Ege University Medical School, Izmir, Turkey. hurender@hotmail.com
authors: Ender
authors: E
authors: Hur
authors: Mehmet
authors: M
authors: Usta
authors: Huseyin
authors: H
authors: Toz
authors: Gulay
authors: G
authors: Asci
authors: Peter
authors: P
authors: Wabel
authors: Serdar
authors: S
authors: Kahvecioglu
authors: Meral
authors: M
authors: Kayikcioglu
authors: Meltem Sezis
authors: MS
authors: Demirci
authors: Mehmet
authors: M
authors: Ozkahya
authors: Soner
authors: S
authors: Duman
authors: Ercan
authors: E
authors: Ok
mesh_terms: D000328:Adult; D001834:Body Water; D058266:Dielectric Spectroscopy; D005260:Female; D015312:Hemodialysis Solutions / Q000008:administration & dosage / Q000032:analysis*; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000628:therapy; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D016896:Treatment Outcome; D014463:Ultrasonography; D059289:Vascular Stiffness; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis* / Q000209:etiology
chemical_list: D015312:Hemodialysis Solutions