The effect of BCM guided dry weight assessment on short-term survival in Chinese hemodialysis patients : Primary results of a randomized trial - BOdy COmposition MOnitor (BOCOMO) study

Li Liu, Yi Sun, Yuqing Chen, Jinsheng Xu, Ping Yuan, Yulan Shen, Shan Lin, Weiming Sun, Yingchun Ma, Jianwei Ren, Wenjun Liu, Jinghong Lei, Li Zuo, Li Liu, Yi Sun, Yuqing Chen, Jinsheng Xu, Ping Yuan, Yulan Shen, Shan Lin, Weiming Sun, Yingchun Ma, Jianwei Ren, Wenjun Liu, Jinghong Lei, Li Zuo

Abstract

Background: Lack of accurate and effective assessment tools of fluid status is one of the major challenges to reach proper dry weight (DW) in chronic hemodialysis (HD) population. The aim of this randomized study was to evaluate the effect of bioimpedance guided DW assessment on long-term outcomes in Chinese HD patients. Eligible patients were randomly assigned (1:1) to two groups in each center, the control group and body composition monitor (BCM) group. In the BCM group, DW has been evaluated by bioimpedance technic every 2 months during follow-up. The primary composite endpoint consisted of death, acute myocardial infarction, cerebral infarction, cerebral hemorrhage, and peripheral vascular disease.

Methods: A total of 445 patients were recruited from 11 hemodialysis centers from Beijing, Tianjin and Shijiazhuang cities from Jan 1, 2013 to Dec 31, 2014. They were randomized into either BCM group or control group. All patients have been followed up for 1 year or until Dec 31, 2014 or censoring.

Results: At baseline, there were no significant differences between two groups in terms of demographic parameters, dialysis vintage, percentage of vascular access, and comorbid conditions. At the end of the study, 18 (4.04%) patients had died (11 in control group and 7 in BCM group). Kaplan-Meier survival analysis showed no significant difference in survival rates between two groups (log-rank test P = 0.07). However, there was an increasing trend of survival rates in BCM group compared to the control group. In the multivariable Cox analysis, there was a nonsignificant trend toward less primary composite end points in the BCM group in the adjusted analysis, the hazard ratio was impressive (0.487, 95% CI 0.217-1.091, P = 0.08).

Conclusion: Bioimpedance technic has been applied to assess fluid status for decades and has been proved to be a promising tool for clinical practice. Although short-term outcomes were not improved in the randomized, controlled trial, the ascending trend in survival has been observed. Further studies are needed to investigate the survival benefit of bioimpedance method in DW assessment in a larger sample with longer follow-up period.

Trial registration: ClinicalTrials.org, NCT01509937. Registered 13 January 2012.

Keywords: Bioimpedance; Body composition monitor; Dry weight; Hemodialysis; Hydration status; Mortality.

Conflict of interest statement

All the authors declare that they have no relevant financial interests in connection with the work submitted.

Figures

Fig. 1
Fig. 1
Flow diagram of the trial
Fig. 2
Fig. 2
The OH values at each visit. OH: overhydration
Fig. 3
Fig. 3
Kaplan-Meier curve comparing the survival between the BCM group and Conventional group over. BCM: body-composition-monitor. (HR = 0.51, 95% confidence interval: 0.24–1.08, log-rank test p-value = 0.07)

References

    1. Wizemann V, Wabel P, Chamney P, et al. The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant. 2009;24(5):1574–1579. doi: 10.1093/ndt/gfn707.
    1. Zoccali C, Moissl U, Chazot C, et al. Chronic fluid overload and mortality in ESRD. J Am Soc Nephrol. 2017;28(8):2491–2497. doi: 10.1681/ASN.2016121341.
    1. Hecking M, Moissl U, Genser B, et al. Greater fluid overload and lower interdialytic weight gain are independently associated with mortality in a large international hemodialysis population. Nephrol Dial Transplant. 2018;33(10):1832–1842. doi: 10.1093/ndt/gfy083.
    1. Dekker MJ, Marcelli D, Canaud BJ, et al. Impact of fluid status and inflammation and their interaction on survival: a study in an international hemodialysis patient cohort. Kidney Int. 2017;91(5):1214–1223. doi: 10.1016/j.kint.2016.12.008.
    1. Onofriescu M, Siriopol D, Voroneanu L, et al. Overhydration, cardiac function and survival in hemodialysis patients. PLoS One. 2015;10(8):e0135691. doi: 10.1371/journal.pone.0135691.
    1. Tabinor M, Elphick E, Dudson M, Kwok CS, Lambie M, Davies SJ. Bioimpedance-defined overhydration predicts survival in end stage kidney failure (ESKF): systematic review and subgroup meta-analysis. Sci Rep. 2018;8(1):4441. doi: 10.1038/s41598-018-21226-y.
    1. Dekker M, Konings C, Canaud B, et al. Pre-dialysis fluid status, pre-dialysis systolic blood pressure and outcome in prevalent haemodialysis patients: results of an international cohort study on behalf of the MONDO initiative. Nephrol Dial Transplant. 2018;33(11):2027–2034. doi: 10.1093/ndt/gfy095.
    1. Siriopol D, Siriopol M, Stuard S, et al. An analysis of the impact of fluid overload and fluid depletion for all-cause and cardiovascular mortality. Nephrol Dial Transplant. 2019;34(8):1385–1393. doi: 10.1093/ndt/gfy396.
    1. Jansen MA, Hart AA, Korevaar JC, et al. Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int. 2002;62(3):1046–1053. doi: 10.1046/j.1523-1755.2002.00505.x.
    1. Puskar D, Pasini J. Savić, Bedalov G, Sonicki Z. survival of primary arteriovenous fistula in 463 patients on chronic hemodialysis. Croat Med J. 2002;43(3):306–311.
    1. Mizumasa T, Hirakata H, Yoshimitsu T, et al. Dialysis-related hypotension as a cause of progressive frontal lobe atrophy in chronic hemodialysis patients: a 3-year prospective study. Nephron Clin Pract. 2004;97(1):c23–c30. doi: 10.1159/000077592.
    1. John AS, Tuerff SD, Kerstein MD. Nonocclusive mesenteric infarction in hemodialysis patients. J Am Coll Surg. 2000;190(1):84–88. doi: 10.1016/S1072-7515(99)00226-4.
    1. Shoji T, Tsubakihara Y, Fujii M, Imai E. Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Int. 2004;66(3):1212–1220. doi: 10.1111/j.1523-1755.2004.00812.x.
    1. Tislér A, Akócsi K, Hárshegyi I, et al. Comparison of dialysis and clinical characteristics of patients with frequent and occasional hemodialysis-associated hypotension. Kidney Blood Press Res. 2002;25(2):97–102. doi: 10.1159/000063515.
    1. Cheriex EC, Leunissen KM, Janssen JH, Mooy JM, van Hooff JP. Echography of the inferior vena cava is a simple and reliable tool for estimation of 'dry weight' in haemodialysis patients. Nephrol Dial Transplant. 1989;4(6):563–568.
    1. Lee SW, Song JH, Kim GA, Lim HJ, Kim MJ. Plasma brain natriuretic peptide concentration on assessment of hydration status in hemodialysis patient. Am J Kidney Dis. 2003;41(6):1257–1266. doi: 10.1016/S0272-6386(03)00358-5.
    1. Vasko R, Müller GA, Ratliff BB, Jung K, Gauczinski S, Koziolek MJ. Clinical judgment is the most important element in overhydration assessment of chronic hemodialysis patients. Clin Exp Nephrol. 2013;17(4):563–568. doi: 10.1007/s10157-012-0745-9.
    1. Canaud B, Lertdumrongluk P. Probing 'dry weight' in haemodialysis patients: 'back to the future'. Nephrol Dial Transplant. 2012;27(6):2140–2143. doi: 10.1093/ndt/gfs094.
    1. Wabel P, Moissl U, Chamney P, et al. Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload. Nephrol Dial Transplant. 2008;23(9):2965–2971. doi: 10.1093/ndt/gfn228.
    1. Moissl UM, Wabel P, Chamney PW, et al. Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas. 2006;27(9):921–933. doi: 10.1088/0967-3334/27/9/012.
    1. van den Ham EC, Kooman JP, Christiaans MH, et al. Body composition in renal transplant patients: bioimpedance analysis compared to isotope dilution, dual energy X-ray absorptiometry, and anthropometry. J Am Soc Nephrol. 1999;10(5):1067–1079.
    1. McClanahan BS, Stockton MB, Lanctot JQ, et al. Measurement of body composition in 8-10-year-old African-American girls: a comparison of dual-energy X-ray absorptiometry and foot-to-foot bioimpedance methods. Int J Pediatr Obes. 2009;4(4):389–396. doi: 10.3109/17477160902763358.
    1. Lintsi M, Kaarma H, Kull I. Comparison of hand-to-hand bioimpedance and anthropometry equations versus dual-energy X-ray absorptiometry for the assessment of body fat percentage in 17-18-year-old conscripts. Clin Physiol Funct Imaging. 2004;24(2):85–90. doi: 10.1111/j.1475-097X.2004.00534.x.
    1. Pillon L, Piccoli A, Lowrie EG, Lazarus JM, Chertow GM. Vector length as a proxy for the adequacy of ultrafiltration in hemodialysis. Kidney Int. 2004;66(3):1266–1271. doi: 10.1111/j.1523-1755.2004.00881.x.
    1. Onofriescu M, Hogas S, Voroneanu L, et al. Bioimpedance-guided fluid management in maintenance hemodialysis: a pilot randomized controlled trial. Am J Kidney Dis. 2014;64(1):111–118. doi: 10.1053/j.ajkd.2014.01.420.
    1. Liu L, Long G, Ren J, et al. A randomized controlled trial of long term effect of BCM guided fluid management in MHD patients (BOCOMO study): rationales and study design. BMC Nephrol. 2012;13:120. doi: 10.1186/1471-2369-13-120.
    1. Chamney PW, Wabel P, Moissl UM, et al. A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr. 2007;85(1):80–89. doi: 10.1093/ajcn/85.1.80.
    1. Machek P, Jirka T, Moissl U, Chamney P, Wabel P. Guided optimization of fluid status in haemodialysis patients. Nephrol Dial Transplant. 2010;25(2):538–544. doi: 10.1093/ndt/gfp487.
    1. Moissl U, Arias-Guillen M, Wabel P, et al. Bioimpedance-guided fluid management in hemodialysis patients. Clin J Am Soc Nephrol. 2013;8(9):1575–1582. doi: 10.2215/CJN.12411212.
    1. Hur E, Usta M, Toz H, et al. Effect of fluid management guided by bioimpedance spectroscopy on cardiovascular parameters in hemodialysis patients: a randomized controlled trial. Am J Kidney Dis. 2013;61(6):957–965. doi: 10.1053/j.ajkd.2012.12.017.
    1. Vujicic B, Mikolasevic I, Racki S, Orlic L, Ljutic D, Bubic I. BCM--body composition monitor: a new tool for the assessment of volume-dependent hypertension in patients on maintenance haemodialysis. Coll Antropol. 2013;37(3):815–819.
    1. Onofriescu M, Mardare NG, Segall L, et al. Randomized trial of bioelectrical impedance analysis versus clinical criteria for guiding ultrafiltration in hemodialysis patients: effects on blood pressure, hydration status, and arterial stiffness. Int Urol Nephrol. 2012;44(2):583–591. doi: 10.1007/s11255-011-0022-y.
    1. Huan-Sheng C, Yeong-Chang C, Ming-Hsing H, et al. Application of bioimpedance spectroscopy in Asian dialysis patients (ABISAD-III): a randomized controlled trial for clinical outcomes. Int Urol Nephrol. 2016;48(11):1897–1909. doi: 10.1007/s11255-016-1415-8.
    1. Patel HV, Annigeri RA, Kowdle PC, et al. Bioimpedance spectroscopy-guided ultrafiltration normalizes hydration and reduces Intradialytic adverse events in hemodialysis patients. Indian J Nephrol. 2019;29(1):1–7.
    1. Covic A, Ciumanghel AI, Siriopol D, et al. Value of bioimpedance analysis estimated "dry weight" in maintenance dialysis patients: a systematic review and meta-analysis. Int Urol Nephrol. 2017;49(12):2231–2245. doi: 10.1007/s11255-017-1698-4.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe