| 1st author Year of publication Reference | Aim of the study | Study design Method of BP measurement Follow-up period | Number Population (Country, KRT modality) | Primary analysis | Results/Conclusion |
|---|---|---|---|---|---|
| Agarwal, 2009 (110) | To assess the participation of interdialytic body weight gain variations in the seasonal profile of blood pressure | Prospective observational trial Routine systolic and diastolic blood pressure while in a supine position on dialysis Observation for 7 years and 6 months; mean follow up time 42.6 ± 3.4 months | 99 stable satellite HD patients France HD | The effect of interdialytic body weight gain variations in the seasonal profile of blood pressure | Blood pressure varied throughout the year, following a cyclic pattern. Systolic and diastolic blood pressures were strongly correlated with interdialytic body weight gain (r= 0.925; P < 0.0001 and r= 0.888; P= 0.0001, respectively) |
| Agarwal, 2016 (111) | To evaluate the effect of lowering home BP on change in symptoms | Sub analysis of RCT Follow up 1 year BP measurement: Mid-week 44hr ambulatory blood pressure monitoring | 133 Single centre USA HD | Correlation between fall in BP from baseline and improved uraemic (P<0.05) and cardiovascular (P<0.001) symptoms without an increase (P=0.047) in dialysis related symptoms | Reducing BP is association with improvement of symptoms including those unrelated to volume excess. |
| Dasgupta, 2019 (31) | Evaluate the association between haemodialysis unit practices related to fluid volume and all-cause mortality | Retrospective cohort study Follow up 3 years Method of BP measurement: Non standardised | 10,250 International (DOPPS database) HD | 10 faculty practices as reported by dialysis unit medical directors were associated with all cause and CV mortality | After multivariate adjustment the following reported practices were associated with improved outcomes. Having a protocol specifying how often to assess dry weight was associated with lower all-cause (HR, 0.78; 99% CI], 0.64 to 0.94) and cardiovascular mortality (HR, 0.72; 99% CI, 0.55 to 0.95). Routine orthostatic BP measurement to assess dry weight was associated with lower all-cause hospitalization (HR, 0.86; 99% CI, 0.77 to 0.97) and cardiovascular events (HR, 0.85; 99% CI, 0.73 to 0.98). Routine use of lower dialysate temperature to limit or prevent intradialytic hypotension was associated with lower cardiovascular mortality (HR, 0.76; 99% CI, 0.58 to 0.98). Routine use of an online volume indicator to assess dry weight was associated with higher all-cause hospitalization (HR, 1.19; 99% CI, 1.02 to 1.38). Routine use of sodium profiling to limit or prevent intradialytic hypotension was associated with higher all-cause mortality (HR, 1.36; 99% CI, 1.14 to 1.63), cardiovascular mortality (HR, 1.34; 99% CI, 1.04 to 1.73), and cardiovascular events (HR, 1.21; 99% CI, 1.03 to 1.43). Conclusion: haemodialysis facility practices are associated with different patient outcomes. The results emphasize the importance of regular and careful clinical assessment of target weight and fluid balance |
| Davies, 2023 (112) | To determine whether bioimpedance guided target dry weight assessment preserves residual renal function | Prospective randomised open label trial Follow up 24 months Method of BP measurement: Median of weekly systolic/diastolic BPs taken as per routine care. | 439 uric (>500ml) Multicentre UK HD | Primary outcome was time to anuria Secondary end points: rate of residual renal function decline blood pressure and patient-reported outcomes | Compared to standard care, the addition of bioimpedance knowledge did not lead to a preservation of RRF (HR 0.751 ;95% CI 0.459-1.229, p=0.254). No significant difference in any secondary end points between groups. Conclusion: bioimpedance is not useful above routine care in targeting dry weight to preserve RRF. |
| Dekker, 2018 (106) | Evaluate the association between pre-dialysis fluid status and pre-SBP on 1 year all-cause mortality | Retrospective cohort study Follow up 1 year Blood pressure was measured prior to the start of dialysis in the clinic in seated position using an oscillometric method. | 8,883 International multicentre (MONDO database) HD | Association of pre dialysis fluid status classified as overloaded (>+1.1 to +2.5 L) or fluid deplete (<-1.1L) using BCM versus normovolaemia and pre dialysis systolic blood pressure status measured using non-standardised in-centre BP measurements classified as low (<110mmHg) normotensive 110-140mmHg) versus >140) | In normotensive patients both pre-dialysis fluid overload [adjusted HR 1.57 (95% CI 1.21–2.04)] and fluid deplete [adjusted HR 1.95 (95% CI 1.08–3.51)] were associated with increased mortality risk. In euvolemic patients, low pre-SBP <110 mmHg was associated with better survival [adjusted HR 0.46 (95% CI 0.23– 0.91)] Conclusion: Patients with SBP<140 who are euvolemic a have reduced mortality. |
| Flythe, 2015 (105) | Evaluate the associations of post-dialysis weights above and below the prescribed target weight and outcomes | Prospective cohort study Blood pressure was machine-measured in the seated position Follow up: until death/censored median FU 2.1 years | 10,785 Multicentre USA HD | Association of ‘HD target weight’ miss defined as either 2kg above or 2kg below in >30% of dialysis treatments versus those who were on target) with all cause and cardiovascular mortality. | Above target weight miss n=1549 (versus not) was associated with greater all-cause mortality (adjusted hazard ratio, 1.28; 95% confidence interval, 1.15 to 1.43) and cardiovascular mortality (adjusted HR, 1.26; 95% CI, 1.07 to 1.50) Below target weight miss (n=682) in at least 30% of treatments (versus not) was associated with greater all-cause mortality (adjusted hazard ratio, 1.22; 95% confidence interval, 1.05 to 1.40) and cardiovascular mortality (adjusted HR, 1.56; 95% CI, 1.26 to 1.93). Conclusion: Maintenance of euvolemia is associated with reduced mortality |
| Huan‐Sheng, 2016 (116) | Comparison of BCM measured protocolised dry weight targets with clinically determined dry weight on outcomes of all cause hospitalisation, fluid overload, CV events, hypertension and IDH events | Prospective randomized controlled trial 1 year follow up BP measured recumbent after 10min rest | 298 Taiwan Single centre HD | Primary: all-cause hospitalization rate. Secondary: acute fluid overload, CV- related events, hypertension (systolic >150mm/hg) and intra-dialysis events | BCM versus clinical exam did not lead to a difference in hospitalisation, symptoms, or mortality. Average change in weight between baseline and 1 year was no different between groups. No difference in systolic BP between groups. Lower incidence of fluid overload or CV events (0.50 (0.26–0.94 p=0.03) In conclusion: little/no difference between BCM derived dry weight targets and clinically determined dry weight |
| Hur, 2013 (117) | Comparison of BCM targeted dry weight with clinically determined dry weight on LV mass index | Prospective, randomized, and controlled study. 1 year follow up BP measured pre post dialysis, method not described | 156 Multi Centre Turkey HD | 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. | LV mass fell in BCM versus control (95% CI, 19.2 to 1.17 g/m2; P 0.04) BCM group lost more weight than control 0.5 L (95% CI, 0.8 to 0.2; P 0.001 Bigger fall in pre-dialysis systolic (-4.5mm/hg; 95% CI -8.9 to 0.1 p=0.04) and diastolic (-2.6mmHg 95% CI -4.8 to -0.3.p = 0.02) between baseline and 1 year in the BCM versus control group. Similar results were seen in diastolic BP measurements with a 6.6mmhg (p=0.005) and 3.7mm/hg (p=0.002) greater fall in post HD systolic and diastolic BP respectively between BCM and control. LA volume fell in BCM group (1.7ml/m2,p=0.03) but not in control group. No difference in adverse events Conclusions: BCM may help control BP and echo parameters better than clinical examination. |
| Hecking, 2018 (109) | Evaluate the relationship between fluid overload and intradialytic weight gain on all-cause mortality | Retrospective cohort study Median follow up 491 days BP measurement method not described | 38,614 Multicentre International HD | Association of pre and post dialysis relative fluid overload defined as the ratio between absolute fluid overload and extracellular fluid ratio measured using BCM on mortality in an incident HD cohort, in addition IDWG was assessed as an additional exposure over a median of 491 days. | When compared with the second quartile of pre or post dialysis volume overload those patients in the 3rd and 4th quartile of fluid overload had a higher mortality (3rd Quartile Pre HR1.75; 95%CI= 1.59-1.92) 3rd Quartile post HR1.2; 95% CI 1.11-1.3) 4th quartile Pre (HR 1.75 95% CI 1.59-1.92) 4thquartile Post (HR 1.74; 95% CI 1.6-1.9) The lowest quartile of IDWG was associated with highest mortally with the authors suggesting a confounding factor of decreased nutritional intake. Conclusion: both pre HD and post HD volume overload is associated with increased mortality across a range of IDWG. |
| Leung, 2017 (119) | Outcome of blood volume monitoring guided ultrafiltration versus standard of care. | Randomised single blind crossover trial in HD patients with frequent symptomatic IDH BP measurement method not described Follow up 22 weeks | 32 Multicentre Canada HD | Primary end point: the rate of symptomatic IDH. Secondary end points: Proportion of sessions with symptomatic and non-symptomatic IDH, volume status, Troponin, BNP. | Compared to usual care, BVM biofeedback did not alter rate of IDH (p=0.29), nor any of the secondary end points. Conclusion: in IDH prone HD patients blood volume monitoring is no better than clinical care. |
| Loutradis, 2019 (133) | The effect of dry-weight reduction guided by lung ultrasound on ambulatory blood pressure in haemodialysis patients | Randomised open label parallel group trial in clinically euvolemic HD patients. BP measurement method 48h ambulatory BPPre- and post- dialysis BPs were recorded with a validated oscillometric device with the patient sitting for at least 5 minutes. Follow up 8 weeks | 71 Multi centre Greece HD | Primary outcome: the difference between groups in the change of 48-hour SBP between baseline and 8-week. Secondary outcomes changes in 48-hour DBP and other inter- dialytic and intradialytic BP variables | Compared to regular care the lung US group had a fall target weight of -0.71 compared to an increase weight in the standard care group of +0.51 (p<0.001) from baseline to week 8. The Lung US group had a greater fall in 48h ambulatory BP between baseline and week 8:between group difference of 5.9mmHg p=0.03 for systolic and between group difference of 3.3mmHg p=0.03 for diastolic. Similarly, intradialytic BP, 44-hour BP, and daytime or night systolic/diastolic BP during both days of the interdialytic interval were significantly reduced in the active group but remained unchanged in the control group. There was no difference in adverse events between the groups. Conclusion: lung-ultrasound-guided strategy for dry-weight reduction can effectively and safely reduce ambulatory BP levels in haemodialysis patients |
| Luo, 2011 (120) | Comparison between bioimpedance versus standard care in management of fluid status. | Randomised single blind study BP measurement: single reading seated after 5 min resting BP Follow up 12 weeks | 160 Single centre (China) CAPD | Volume status measured using bioimpedance | BCM guided weight reduction lead to less overhydration, lower ICW, lower systolic BP (all p<0.05 compared to standard care. BCM guided fluid management in addition to clinical examination is superior to clinical examination alone in CAPD patients. |
| McIntyre, 2003 (121) | Evaluation of the use of blood volume monitoring biofeedback on tolerability and volume status in a HD cohort | Nonrandomised prospective crossover interventional trial. Follow up 3 weeks BP measurement method not described | 15 Single centre (UK) HD | End points: Patients’ tolerability Intradialytic weight gains, and dialysis adequacy. | BVM reduced frequency of hypotension (p<0.001), symptomatic hypotension (p<0.001), requirement of saline infusions (p<0.001) and IDWG (p=0.009) and increased urea kinetics (11% higher equilibrated Kt/V P<0.01). Conclusion: BVM improved tolerability, reduced fluid gains and increased adequacy in a group of stable HD patients. |
| Nesrallah, 2008 (122) | Evaluation of the use of blood volume monitoring biofeedback on volume status in a HD cohort | Randomised open label prospective trial of BVM versus standard care in volume expanded HD patients to reduce extracellular fluid volume. Follow up 6 months BP method: standing and seated positions before and after HD. | 60 Single centre Canada HD | The primary endpoint: change in ECFV. exploratory end points: frequency of IDH, interdialytic weight gain, and changes in serum Na | BVM biofeedback did not lead to a significant difference in extracellular fluid, blood pressure, IDWG, dialysis adequacy but was associated with a reduction in IDH (p=0.014) compared to standard care. BVM biofeedback was not superior to clinical care in volume management in volume expanded HD patients, but may lead to reduced IDH. |
| Onofriescu, 2012 (123) | Evaluation of the use of bioimpedance versus standard care to guide UF management in a cohort of HD patients | Prospective randomised open label trail of bioimpedance versus standard care in ultrafiltration management BP measurement: The average of three consecutive HD sessions BP was taken after 10 minutes of recumbence using mercury sphygmomanometer. Follow up 12 months | 135 Single centre (Romania) HD | Primary end point not clearly stated. Endpoints included: BP, pulse wave velocity, NT pro BNP | At 12 months the BCM group had a lower systolic and diastolic BP compared to baseline though no documentation of antihypertensive regimen. PWV fell in BCM group, and rose in usual care group. No defence in volume status in either group between baseline and 12 months. Between group comparison not performed so unclear if BCM made any difference and study limited by lack of medication use. |
| Onofriescu, 2015 (108) | Evaluate the associations between pre-dialysis overhydration on all-cause mortality and cardiovascular events | Prospective cohort study BP measurement: ten minutes of recumbence, using a sphygmomanometer. Follow up : median 66.2 months | 221 Single centre Romania HD | Association of relative fluid overload defined as the ratio between absolute fluid overload and extracellular fluid ratio measured using BCM on mortality | After multivariate analysis those who had 15% relative fluid overload had increased mortality (HR = 1.87, 95%CI =1.12–3.13) and cardiovascular events (2.31, 95%CI = 1.42–3.77. Conclusion: volume overloaded associated with increased mortality |
| Patel, 2019 (124) | Evaluation of impact of bioimpedance guided UF compared to routine care on blood pressure control, antihypertensive use and IDH. | Prospective parallel group open label randomised trial. Follow up 6 months. Patients randomised to knowledge of bioimpedance result versus standard care to guide ultrafiltration and target weight. BP measurement: pre/during and post HD, method not specified. | 50 Multi centre India HD | Primary end points blood pressure control, intradialytic complication secondary: anti- hypertensive drug burden. | Blood pressure: no significant difference in systolic, diastolic or MAP at 6 months between groups. No difference in the change in the systolic or diastolic pressure between baseline and 6 months between groups. Weight: no difference in weight between groups at baseline or 6 months. Fewer dialysis episodes of IDH (p=0.003), cramps (p=0.048) and dizziness (p=0.012) in the BIS group. No difference change in weight between groups. Medication use: BIS guided UF did not make a difference in amount of antihypertensives used at 6 months, but did demonstrated a bigger change in the amount of antihypertensive use between baseline and 6 months (p=0.008). Conclusion: Bioimpedance guided UF management is not superior to routine care in target weight, or absolute blood pressure parameters. However it may reduce patients symptoms and may allow a reduction in antihypertensive medication use. |
| Santoro, 2002 (126) | Does blood volume biofeedback improve dialysis tolerance in hypotension proone HD patients | Prospective, randomized, crossover study Follow up duration 4 months Randomised patients into blood volume biofeedback versus usual care. BP measured pre and post dialysis supine and standing. No additional specified methods. | 36 Multicentre Italy HD | Primary end point: difference in acute hypotension episodes between groups | Patients using blood volume biofeedback has a 30% lower (p=0.004) IDH events, and 10% reduction in inter dialysis symptoms (p<0.001) compared to standard care with no change in weight, Kt/v or pre HD BP. BVM in hypotension prone HD patients may improve patients’ symptoms on dialysis. |
| Selby, 2006 (127) | Does biofeedback versus usual care haemodialysis improve cardiac function | Prospective open label randomised crossover study. Male HD patients ‘prone to hypotension’ were assigned to either 2 weeks of usual care or 2 weeks of blood volume monitoring biofeedback dialysis followed by crossover. Follow up 4 weeks. BP measurement: pre/during and post HD, method not specified. | 8 Single centre UK HD | Primary end point: change in LV regional wall motion abnormalities (RWMA). | Biofeedback dialysis led to higher intra dialysis systolic and diastolic pressure, significantly fewer RWMA (OR 0.6 CI 0.39-0.91) and fewer new RWMA at peak stress (p=0.02). |
| Siriopol, 2017 (128) | Evaluation of dry weight assessment using lung US and bioimpedance versus standa rd care | Prospective parallel group open label RCT. BP measurement: method not specified. Follow up 24 months | 250 Multicentre Romania HD | Primary end point: All composite of cause mortality and first CV event | Compared to standard care lung uss and bioimpedance guided dry weight did not alter mortality of CV events. Standard care lead to greater dyspnoea but less cramps. LUS–bioimpedance-guided dry weight adjustment is not superior to standard care. |
| Yoon, 2019 (129) | Evaluation of Bioimpedance spectroscopy-guided fluid management in peritoneal dialysis patients with residual kidney function | Prospective parallel group open label randomised controlled trial BP measurement: method not specified. Median follow up 36 months | 201 Multicentre South Korea PD | Primary end point: RRF at 12 months And CV events at 36 months | No significant difference between groups in terms of volume status, RRF, BP, weight, CV events. Bioimpedance no better than standard of care. |
| Zoccali, 2021 (132) | Evalution of lung ultrasound guided volume management strategy on MACE | Prospective open label parallel group randomised controlled trial Mean follow up duration 1.49 years Pre- and post- dialysis BPs were recorded with a validated oscillometric device with the patient sitting for at least 5 minutes. | 367 International multicentre HD | Primary end point: death, non-fatal MI, decompensated heart failure. | Compared to usual care, lung us guided volume target, did not alter MACE, echo parameters, hospitalisations or patient reported outcomes. There was no significant difference in blood pressure, IDGW or target weight between groups. Lung US does not appear to be superior to standard care in assessing target weight. |
| Zoccali, 2017 (107) | Evaluate the associations between chronic overhydration and all-cause mortality | Retrospective cohort study BP measurement method: not stated Follow-up 1 year | 39, 556 International multicentre HD | In an incident dialysis population the association of fluid overload (defined as the ratio between absolute fluid overload and extracellular fluid ratio measured using BCM with >15% in men and >13% in women classed as fluid overloaded) 1 year on mortality. | Baseline fluid overload was associated with increased mortality across categories of pre systolic blood pressure measurement. (<130 mmHg: HR, 1.51; 95% CI, 1.38 to 1.65; 130–160 mmHg: HR, 1.25; 95% CI, 1.16 to 1.36; >160 mmHg: HR, 1.30; 95% CI, 1.19 to 1.42; all P<0.001). 1 year cumulative fluid overload predicted a higher death risk across pre systolic BP categories (<130 mmHg: HR, 1.94; 95% CI, 1.68 to 2.23; 130–160 mmHg: HR, 1.51; 95% CI, 1.35 to 1.69; >160 mmHg: HR, 1.62; 95% CI, 1.39 to 1.90). Both baseline overhydration and 1-year cumulative overhydration associated with increased mortality. |
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