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Bioimpedance Devices for the Assessment of Body Fluid Volume for Patients Undergoing Dialysis: A Review of the Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Last updated: March 17, 2014
Project Number: RC0534-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Report in Brief

Context
Patients with end-stage renal disease require lifetime renal replacement therapy, most often with either hemodialysis or peritoneal dialysis. During dialysis, hemodynamic instability — hypotension or hypertension — is a common occurrence, which can lead to cardiovascular complications such as left ventricular hypertrophy. An accurate estimation of a patient's body fluid volume can help prevent hemodynamic instability. While subjective methods of estimating body fluid volume can be used, objective methods have been developed to provide more accurate estimates. These include blood volume monitoring, natriuretic peptide measurements, extravascular lung water indices, and bioimpedance methods.

Technology
Bioimpedance devices pass an electrical current through the body and estimate the body fluid volume by the amount of resistance this current endures in the body tissues. Several studies have shown that this method is accurate and reliable for the assessment of body fluids.

Issue
A review of the clinical and cost-effectiveness of, and the evidence-based clinical guidelines for bioimpedance devices will help inform the use of this technology for fluid management in renal dialysis patients.

Methods
A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).

Results
The literature search identified 264 citations, with 1 additional article identified from other sources. After screening the abstracts, 9 were deemed potentially relevant, and 5 met the criteria for inclusion in this review — 3 randomized controlled trials and 2 uncontrolled studies.

Key Messages

  • The use of bioimpedance devices as adjunctive tools in fluid management may lead to better patient outcomes such as decreased blood pressure, reduced fluid overload, and decreased left ventricular mass index (based on limited evidence).
  • No cost-effectiveness information or guidelines on bioimpedance devices for fluid management in renal dialysis patients were found.

Question

  1. What is the clinical effectiveness of bioimpedance devices for the assessment of body fluid volume status in patients with renal disease who are on peritoneal dialysis or hemodialysis?
  2. What is the cost-effectiveness of bioimpedance devices for the assessment of body fluid volume status in patients with renal disease who are on peritoneal dialysis or hemodialysis?
  3. What are the evidence-based guidelines regarding the use of bioimpedance devices for the assessment of body fluid volume status in patients with renal disease who are on peritoneal dialysis or hemodialysis?

Key Message

Five studies on the effectiveness of bioimpedance spectrometry devices were included in the review. The literature search did not identify any cost-effectiveness analyses or clinical guidelines. The included studies showed limited evidence that the use these devices as adjunctive tools in fluid-management might be associated with better patient outcomes such as decreased blood pressure, reduced fluid overload, and decreased left ventricular mass index.