Volume Assessment in Patients Undergoing Long-Term Dialysis.
Every available method of assessing fluid status in long-term dialysis is imperfect, and neither lung ultrasound nor bioelectrical impedance analysis has yet shown convincingly favourable clinical outcomes in trials. The authors call for a systematic, globally coordinated approach to volume assessment rather than another single new technology.
Background
Accurate assessment of fluid status is a priority for patients with kidney failure receiving long-term dialysis. Volume-related practices vary widely between dialysis units, and clinical decisions on volume management rest implicitly on an assessment of volume status for which there is no agreed standard — creating an urgent need for better evidence to guide practice.
Key findings
The review appraises the available methods and finds each limited. Isotope-based dilution techniques are impractical for clinical use and may not serve as a gold standard in kidney failure. Individual trends in body weight and blood pressure are used as pragmatic surrogates, and probing the target weight on the basis of blood pressure remains widely practised, but this may carry risks of volume depletion and accelerated loss of residual kidney function. Clinical signs such as elevated jugular venous pressure and leg oedema are readily accessible but have poor diagnostic accuracy and wide interobserver variability, limiting their reproducibility in clinical trials. Lung ultrasound and bioelectrical impedance analysis have a sound scientific rationale for assessing extracellular volume and are appropriately associated with clinical outcomes, yet neither has demonstrated convincingly favourable clinical outcomes in trials. Other technologies exist but require further assessment.
Clinical implications
The authors argue that progress can be made with existing technologies rather than awaiting new ones — through comparative effectiveness trials of different fluid management strategies, routine and standardised measurement of volumetric parameters alongside individual patient preferences, and innovative integration of the existing assessment methods. A systematic and globally coordinated approach to improving volume assessment and management is required to improve outcomes for patients receiving long-term dialysis.
Category
Transplant
Source
J Am Soc Nephrol
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