Combining bioimpedance and clinical assessment for individualised fluid management in haemodialysis

Abstract

Fluid management in haemodialysis is a delicate balancing act. Determination of target weight mainly relies on clinical assessment, but this may be subjective and imprecise. There is a need to find methods that can reduce the prevalence of chronic fluid overload and intra- and inter-dialytic symptoms related to fluid alterations in people with chronic kidney disease treated with haemodialysis. New technologies like bioimpedance can be used as aids in fluid management and target weight estimation in haemodialysis; however, these methods cannot be expected to provide a simple target applicable to all patients. This summary report reflects some of the current evidence and empirical knowledge on fluid management in haemodialysis. It stresses the importance of paying careful attention to patients' fluid status and provides suggestions for an individualised approach to target weight estimation. The report highlights several patient-related factors that may impact bioimpedance measurements, as well as treatment components that should be involved in the decision process of fluid management, target weight estimation and bioimpedance.