Wathanavasin Wannasit, Thongprayoon Charat, Davis Paul W, Cheungpasitporn Wisit
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN.
Nephrology Unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand.
Kidney Med. 2025 Jun 17;7(8):101052. doi: 10.1016/j.xkme.2025.101052. eCollection 2025 Aug.
RATIONALE & OBJECTIVE: Recently, various instrumental techniques adjunct to standard clinical evaluation have been used to improve fluid balance and guide dry weight adjustments in dialysis populations. We aimed to explore the efficacy and safety of using technology-guided dry weight adjustment among dialysis patients.
Systematic review and meta-analysis of randomized controlled trials (RCTs). The search was conducted in PubMed, Scopus, and Cochrane Central Register of Controlled Trials for relevant RCTs published until April 28, 2024.
SETTING & PARTICIPANTS: Adult patients with kidney failure with replacement therapy.
Studies with patients receiving technology-guided dry weight adjustments.
Studies were selected if they reported at least 1 outcome of interest (eg, mortality, cardiovascular [CV] events, hospitalization, intradialytic hypotension, hypovolemic events, cardiac arrhythmia, or vascular access problems).
Random-effects meta-analyses were conducted, with risk of bias within studies assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials.
A total of 21 RCTs involving 4,239 dialysis patients were analyzed. The meta-analysis revealed that the incorporating technology-guided dry weight adjustment not only was associated with a significant 21% reduction in CV events (relative risk, 0.79; 95% confidence interval [CI], 0.71-0.88) but also resulted in a significant 9% increase in muscle cramps (rate ratio, 1.09; 95% CI, 1.02-1.16). In a subgroup analysis, using bioelectrical impedance analysis was associated with a significant reduction in mortality (relative risk, 0.67; 95% CI, 0.51-0.89). In addition, the intervention led to a significant reduction in pulse wave velocity (mean difference, -2.43 m/s; 95% CI, -4.64 to -0.21).
Large number of studies with some concerns or a high risk of bias.
Technology-guided strategies for dry weight adjustment significantly reduce CV events and may lower all-cause mortality in dialysis patients. These benefits are particularly evident with bioelectrical impedance analysis--guided interventions. Nonetheless, clinicians should be aware of a modestly increased risk of muscle cramps.
最近，除标准临床评估外，各种仪器技术已被用于改善透析人群的液体平衡并指导干体重调整。我们旨在探讨在透析患者中使用技术指导的干体重调整的疗效和安全性。
对随机对照试验（RCT）进行系统评价和荟萃分析。在PubMed、Scopus和Cochrane对照试验中央注册库中检索截至2024年4月28日发表的相关RCT。
接受替代治疗的成年肾衰竭患者。
患者接受技术指导的干体重调整的研究。
如果研究报告了至少1项感兴趣的结局（如死亡率、心血管[CV]事件、住院、透析中低血压、低血容量事件、心律失常或血管通路问题），则将其纳入。
进行随机效应荟萃分析，使用Cochrane随机试验偏倚风险工具第2版评估研究中的偏倚风险。
共分析了21项涉及4239例透析患者的RCT。荟萃分析显示，采用技术指导的干体重调整不仅与CV事件显著降低21%相关（相对风险，0.79；95%置信区间[CI]，0.71 - 0.88），而且还导致肌肉痉挛显著增加9%（率比，1.09；95%CI，1.02 - 1.16）。在亚组分析中，使用生物电阻抗分析与死亡率显著降低相关（相对风险，0.67；95%CI，0.51 - 0.89）。此外，该干预导致脉搏波速度显著降低（平均差，-2.43 m/s；95%CI，-4.64至-0.21）。
大量研究存在一些问题或偏倚风险较高。
技术指导的干体重调整策略可显著降低透析患者的CV事件，并可能降低全因死亡率。这些益处尤其在生物电阻抗分析指导的干预中明显。尽管如此，临床医生应意识到肌肉痉挛风险略有增加。
