title: Dry weight assessment by combined ultrasound and bioimpedance monitoring in low cardiovascular risk hemodialysis patients: a randomized controlled trial.
abstract: OBJECTIVE
  Fluid overload is associated with adverse outcomes in hemodialysis (HD) patients. The precise assessment of hydration status in HD patients remains a major challenge for nephrologists. Our study aimed to explore whether combining two bedside methods, lung ultrasonography (LUS) and bioimpedance, may provide complementary information to guide treatment in specific HD patients.
  
  
  METHODS
  In total, 250 HD patients from two dialysis units were included in this randomized clinical trial. Patients were randomized 1:1 to have a dry weight assessment based on clinical (control) or LUS with bioimpedance in case of clinical hypovolemia (active)-guided protocol. The primary outcome was to assess the difference between the two groups on a composite of all-cause mortality and first cardiovascular event (CVE)-including death, stroke, and myocardial infarction.
  
  
  RESULTS
  During a mean follow-up period was 21.3 ± 5.6 months, there were 54 (21.6%) composite events in the entire population. There was a nonsignificant 9% increase in the risk of this outcome in the active arm (HR = 1.09, 95% CI 0.64-1.86, p = 0.75). Similarly, there were no differences between the two groups when analyzing separately the all-cause mortality and CVE outcomes. However, patients in the active arm had a 19% lower relative risk of pre-dialytic dyspnea (rate ratio-0.81, 95% CI 0.68-0.96), but a 26% higher relative risk of intradialytic cramps (rate ratio-1.26, 95% CI 1.16-1.37).
  
  
  CONCLUSIONS
  This study shows that a LUS-bioimpedance-guided dry weight adjustment protocol, as compared to clinical evaluation, does not reduce all-cause mortality and/or CVE in HD patients. A fluid management protocol based on bioimpedance with LUS on indication might be a better strategy.
authors.affiliation: Nephrology Department, Dialysis and Renal Transplant Center, ''Dr. C.I. Parhon'' University Hospital, ''Grigore T. Popa'' University of Medicine and Pharmacy, No. 50 Carol I Blvd., Iasi, Romania.
authors.forename: Dimitrie
authors.initials: D
authors.lastname: Siriopol
authors.affiliation: Nephrology Department, Dialysis and Renal Transplant Center, ''Dr. C.I. Parhon'' University Hospital, ''Grigore T. Popa'' University of Medicine and Pharmacy, No. 50 Carol I Blvd., Iasi, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Onofriescu
authors.affiliation: Nephrology Department, Dialysis and Renal Transplant Center, ''Dr. C.I. Parhon'' University Hospital, ''Grigore T. Popa'' University of Medicine and Pharmacy, No. 50 Carol I Blvd., Iasi, Romania.
authors.forename: Luminita
authors.initials: L
authors.lastname: Voroneanu
authors.affiliation: Nephrology Department, Dialysis and Renal Transplant Center, ''Dr. C.I. Parhon'' University Hospital, ''Grigore T. Popa'' University of Medicine and Pharmacy, No. 50 Carol I Blvd., Iasi, Romania.
authors.forename: Mugurel
authors.initials: M
authors.lastname: Apetrii
authors.affiliation: Nephrology Department, Dialysis and Renal Transplant Center, ''Dr. C.I. Parhon'' University Hospital, ''Grigore T. Popa'' University of Medicine and Pharmacy, No. 50 Carol I Blvd., Iasi, Romania.
authors.forename: Ionut
authors.initials: I
authors.lastname: Nistor
authors.affiliation: Nephrology Department, Dialysis and Renal Transplant Center, ''Dr. C.I. Parhon'' University Hospital, ''Grigore T. Popa'' University of Medicine and Pharmacy, No. 50 Carol I Blvd., Iasi, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Hogas
authors.affiliation: Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kanbay
authors.affiliation: Cardiology Department, ''Dr. George IM Georgescu'' University Hospital, ''Grigore T. Popa'' University of Medicine and Pharmacy, Iasi, Romania.
authors.forename: Radu
authors.initials: R
authors.lastname: Sascau
authors.affiliation: General Surgery Department, Regional Institute of Oncology, ''Grigore T. Popa'' University of Medicine and Pharmacy, Iasi, Romania.
authors.forename: Dragos
authors.initials: D
authors.lastname: Scripcariu
authors.affiliation: Nephrology Department, Dialysis and Renal Transplant Center, ''Dr. C.I. Parhon'' University Hospital, ''Grigore T. Popa'' University of Medicine and Pharmacy, No. 50 Carol I Blvd., Iasi, Romania. accovic@gmail.com.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
mesh_terms: D000328:Adult; D000368:Aged; D001823:Body Composition; D001834:Body Water; D001835:Body Weight; D002423:Cause of Death; D017097:Electric Impedance; D005260:Female; D005500:Follow-Up Studies; D015312:Hemodialysis Solutions / Q000008:administration & dosage / Q000009:adverse effects; D006760:Hospitalization; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000628:therapy; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009120:Muscle Cramp / Q000209:etiology; D009203:Myocardial Infarction / Q000209:etiology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology*; D020107:Troponin T / Q000097:blood; D014463:Ultrasonography; D059289:Vascular Stiffness
chemical_list: D015312:Hemodialysis Solutions; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Bioimpedance; Cardiovascular events; Fluid status; Hemodialysis; Lung ultrasonography