Incidence of hospital admissions in bioimpedance-guided fluid management among maintenance hemodialysis patients—Results of a randomized controlled trial

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2023-04-17 DOI:10.1111/hdi.13076

Kaiane Stigger, Larissa Ribas Ribeiro, Fernanda Moraez Cordeiro, Maristela Böhlke

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Abstract

Introduction

Hemodialysis is life-sustaining in kidney failure. However, proper regulation of body fluids depends on an accurate estimate of target weight. This trial aims to compare clinical endpoints between target weight estimation guided by bioimpedance spectroscopy and usual care in hemodialysis patients.

Methods

This is an open-label, parallel-group, controlled trial that randomized, through a table of random numbers, adult patients on maintenance hemodialysis to target weight estimation based on monthly clinical evaluation alone or added to evaluation by bioimpedance twice a year. The primary outcome was survival, and the secondary outcomes were the rate of hospital admissions, change in blood pressure (BP), and antihypertensive drugs load. Participants were followed for 2 years. Survival analysis was performed using Kaplan–Meier estimator and Log-rank test, and hospital admissions were analyzed by the incidence-rate ratio.

Findings

One hundred and ten patients were randomized to the usual care (52) or bioimpedance (58) groups, with a mean age of 57.4 (15.4) years, 64 (58%) males. There was no difference between the groups at baseline. Survival was not significantly different between groups (log-rank test p = 0.68), but the trial was underpowered for this outcome. There was also no difference between the groups in the change in systolic or diastolic BP or in the number of antihypertensive drugs being used. The incidence rate of hospital admissions was 3.1 and 2.1 per person-year in usual care and bioimpedance groups, respectively, with a time-adjusted incidence rate ratio of 1.48 (95% CI: 1.20–1.82, p = 0.0001) and attributable fraction of risk among exposed individuals of 0.32 (95% CI: 0.17–0.45).

Discussion

The inclusion of bioimpedance data to guide the estimation of target weight in hemodialysis patients had no detectable impact on survival or BP control, but significantly reduced the incidence rate of hospital admissions.

The study was registered at ClinicalTrials.gov Identifier: NCT05272800.

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维持性血液透析患者采用生物阻抗引导的液体管理的住院率——一项随机对照试验的结果

血液透析是肾衰竭患者的生命维持手段。然而，体液的适当调节取决于对目标体重的准确估计。本试验旨在比较生物阻抗谱指导下的目标体重估计与血液透析患者常规护理的临床终点。方法:这是一项开放标签、平行组、对照试验，通过一个随机数字表，随机选择接受维持性血液透析的成年患者，根据每月的临床评估或每年两次的生物阻抗评估来估计目标体重。主要结局是生存，次要结局是住院率、血压变化(BP)和抗高血压药物负荷。参与者被跟踪了2年。生存率分析采用Kaplan-Meier估计和Log-rank检验，住院率分析采用发病率比。110例患者随机分为常规治疗组(52例)和生物阻抗组(58例)，平均年龄57.4岁(15.4岁)，男性64例(58%)。两组在基线时无差异。两组间生存率无显著差异(log-rank检验p = 0.68)，但该试验对这一结果的支持不足。两组之间收缩压和舒张压的变化以及使用降压药的数量也没有差异。常规护理组和生物阻抗组的住院率分别为3.1和2.1人/年，经时间调整的发病率比为1.48 (95% CI: 1.20-1.82, p = 0.0001)，暴露个体的归因风险分数为0.32 (95% CI: 0.17-0.45)。纳入生物阻抗数据来指导血透患者目标体重的估计对生存或血压控制没有可检测到的影响，但显著降低了住院率。该研究已在ClinicalTrials.gov注册，识别码:NCT05272800。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.