Applying bio-impedance vector analysis (BIVA) to adjust ultrafiltration rate in critically ill patients on continuous renal replacement therapy: A randomized controlled trial

ElsevierVolume 72, December 2022, 154146Journal of Critical CareHighlights•

Bioimpedance vector analysis (BIVA) has been known for decades as a rapid, noninvasive, and inexpensive technique for bedside evaluation of hydration status.

The effectiveness of BIVA in guiding fluid removal by continuous renal replacement therapy (CRRT) has not been evaluated.

In this randomized controlled trial, BIVA guided UF prescription during CRRT was associated with a better control of lean body mass water content.

Larger studies are required to evaluate the impact of applying BIVA as a guide to prescribe UF on the mortality rate, ICU stay duration, or kidney recovery.

AbstractBackground

Bioimpedance vector analysis (BIVA) has been suggested as a valuable tool in assessing volume status in critically ill patients. However, its effectiveness in guiding fluid removal by continuous renal replacement therapy (CRRT) has not been evaluated.

Methods

In this randomized controlled trial, 65 critically ill patients receiving CRRT were allocated on a 1:1 ratio to have UF prescribed and adjusted using BIVA fluid assessment in the intervention group (32 patients) or conventional clinical parameters (33 patients). The primary outcome was the lean body mass (LBM) water content at CRRT discontinuation, and the secondary outcomes included the mortality rate, urinary output, the duration of ventilation support, and ICU stay.

Results

The study group was associated with a lower water content of LBM (80.7 ± 9.4 vs. 85.9 ± 10.4%; p < 0.05), and a higher mean UF-rate and urinary output (1.5 ± 0.8 vs. 1.2 ± 0.5 ml/kg/h and 0.9 ± 0.9 vs 0.5 ± 0.6 ml/kg/h, both: p < 0.05). The mortality rate, the length of ICU stay, and ventilation support duration were similar.

Conclusion

BIVA guided UF prescription may be associated with a lower rate of fluid overload. Larger studies are required to evaluate its impact on patients' outcomes.

Keywords

CRRT

BIVA

AKI

Fluid overload

Ultrafiltration rate

Critical illness

Bio-impedance

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