Clinical Application of Bioelectrical Impedance Analysis for Fluid Assessment in Hemodialysis Patients
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Abstract
Background: Fluid overload is common in maintenance hemodialysis (MHD) patients and is associated with adverse cardiovascular events and mortality. Conventional clinical methods for fluid assessment have limited accuracy. This study evaluated the effectiveness of bioelectrical impedance analysis (BIA) for the fluid evaluation in MHD patients.
Methods: A prospective interventional study was conducted in 34 clinically stable MHD patients at Ranong Hospital from June to August 2025. Fluid status was assessed monthly using BIA, combined with standard of care, and dry body weight was adjusted accordingly. The outcomes were the change in fluid status, expressed as target average fluid overload (TAFO), dialysis-related complications, and blood pressure control before and after BIA-guided management.
Results: At baseline, 67.6% of patients were fluid overloaded, 20.6% were normovolemic, and 11.8% were dehydrated. In the overloaded group, mean TAFO significantly decreased from 3.4 ± 2.8 L to 2.1 ± 2.8 L at 3 months (p = 0.001). Dehydrated patients shifted toward normovolemia, while normovolemic patients remained stable. Dialysis-related complications, including intradialytic hypotension and hypertension, symptoms of cramps and fatigue, improved significantly in the overload group. The mean number of antihypertensive drug classes was also substantially reduced.
Conclusions: BIA-guided fluid management improved fluid control in MHD patients, resulting in reduced dialysis-related complications and fewer anti-hypertensive drug classes. These findings support integrating BIA into standard clinical practice for individualized volume management, particularly in patients with fluid overload.
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