Bioelectrical impedance analysis versus physician adjustment in acute kidney injury patients to reduce intradialytic hypotension: A randomized controlled trial

INTRODUCTION: Volume overload and intradialytic hypotension (IDH) are significant complications that can increase the mortality rate in hemodialysis patients.Bioelectrical impedance analysis (BIA) has been used to estimate the optimum weight in chronic hemodialysis patients to prevent intradialytic hypotension. However, data regarding BIA for evaluating hydration in acute kidney injury patients is scarce. We reported the case series of 9 patients who used BIA in comparison with physician adjustment to prevent intradialytic hypotension in patients with acute kidney injury who received renal replacement therapy. METHODS: We randomized 9 patients with acute kidney injury (AKI) and volume overload who underwent 45 sessions of acute hemodialysis at Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand between October 2017 and February 2018 to BIA and physician –adjusted group. Volume overload was defined as a BIA value of more than>0.4. In the physician-adjusted group (control), the estimates for physical examination and fluid balance were recorded. The primary outcome was an intradialytic hypotensive episode.The secondary outcome was hemodialysis-related adverse events and other clinical outcomes. This work is fully compliant with CONSORT criteria (detailed in the supplemental file) RESULT: Among 9 patients (55.6% male, median age 65.56 years),the main underlying diseases were hypertension and diabetes mellitus. The main cause of AKI was sepsis. After randomization of overall of 45 sessions in 9 patients with AKI, the intradialytic hypotension event rate in the BIA group was significantly lower than that in the control group (5 events vs 12 events; P = 0.042). There were no differences in the rates of hemodialysis-related adverse events and other clinical outcomes between the two groups. CONCLUSION: The use of bioelectrical impedance analysis-guided ultrafiltration in patients with acute kidney injury requiring renal replacement therapy can help reduce intradialytic hypotension.