Why assistive technology is needed for probing of dry weight

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Despite advancements in dialysis therapy, the subjective clinical examination still remains the standard of care in managing volume removal in chronic dialysis. While there is no definitive trial establishing that dry weight management guided by an assistive technology is superior to the clinical method, there is ample evidence that there is a need for these technologies to be developed. Mortality, cardiovascular morbidity, and sequelae of volume overload remain far too common under the current paradigm. Recent studies indicate that the mortality associated with volume overload is independent of hypertension, suggesting that if mortality is to be improved, then a measure of volume independent of blood pressure must be developed. Even when considered as an integrated whole, the clinical method is inaccurate at setting dry weight when compared to the use of assistive technologies. A recent secondary analysis of a randomized trial showed that relative plasma volume (RPV) slope is responsive to change in volume status and may be useful in guiding therapy for hypertension. The only large randomized trial to investigate the ability of an assistive technology to manage volume removal in hemodialysis patients is the Crit-Line Intradialytic Monitoring Benefit Study, which found harm associated with RPV monitoring. However, the design of this trial did not require the RPV group to actually receive this intervention. Assistive technologies offer an opportunity to improve on the subjective clinical exam for the setting of dry weight, but well designed and adequately powered clinical trials are needed.

Original languageEnglish
Pages (from-to)197-202
Number of pages6
JournalBlood Purification
Volume31
Issue number1-3
DOIs
StatePublished - Jan 2011

Fingerprint

Self-Help Devices
Plasma Volume
Weights and Measures
Mortality
Dialysis
Hypertension
Standard of Care
Renal Dialysis
Clinical Trials
Blood Pressure
Technology
Morbidity
Therapeutics

Keywords

  • Bioimpedance
  • Blood pressure
  • Dry weight
  • End-stage renal disease
  • Hemodialysis
  • Hypertension
  • Physical exam
  • Relative plasma volume
  • Volume status

ASJC Scopus subject areas

  • Nephrology
  • Hematology

Cite this

Why assistive technology is needed for probing of dry weight. / Sinha, Arjun.

In: Blood Purification, Vol. 31, No. 1-3, 01.2011, p. 197-202.

Research output: Contribution to journalArticle

@article{88c8612f3b3a4303a33e65629306c3af,
title = "Why assistive technology is needed for probing of dry weight",
abstract = "Despite advancements in dialysis therapy, the subjective clinical examination still remains the standard of care in managing volume removal in chronic dialysis. While there is no definitive trial establishing that dry weight management guided by an assistive technology is superior to the clinical method, there is ample evidence that there is a need for these technologies to be developed. Mortality, cardiovascular morbidity, and sequelae of volume overload remain far too common under the current paradigm. Recent studies indicate that the mortality associated with volume overload is independent of hypertension, suggesting that if mortality is to be improved, then a measure of volume independent of blood pressure must be developed. Even when considered as an integrated whole, the clinical method is inaccurate at setting dry weight when compared to the use of assistive technologies. A recent secondary analysis of a randomized trial showed that relative plasma volume (RPV) slope is responsive to change in volume status and may be useful in guiding therapy for hypertension. The only large randomized trial to investigate the ability of an assistive technology to manage volume removal in hemodialysis patients is the Crit-Line Intradialytic Monitoring Benefit Study, which found harm associated with RPV monitoring. However, the design of this trial did not require the RPV group to actually receive this intervention. Assistive technologies offer an opportunity to improve on the subjective clinical exam for the setting of dry weight, but well designed and adequately powered clinical trials are needed.",
keywords = "Bioimpedance, Blood pressure, Dry weight, End-stage renal disease, Hemodialysis, Hypertension, Physical exam, Relative plasma volume, Volume status",
author = "Arjun Sinha",
year = "2011",
month = "1",
doi = "10.1159/000321840",
language = "English",
volume = "31",
pages = "197--202",
journal = "Blood Purification",
issn = "0253-5068",
publisher = "S. Karger AG",
number = "1-3",

}

TY - JOUR

T1 - Why assistive technology is needed for probing of dry weight

AU - Sinha, Arjun

PY - 2011/1

Y1 - 2011/1

N2 - Despite advancements in dialysis therapy, the subjective clinical examination still remains the standard of care in managing volume removal in chronic dialysis. While there is no definitive trial establishing that dry weight management guided by an assistive technology is superior to the clinical method, there is ample evidence that there is a need for these technologies to be developed. Mortality, cardiovascular morbidity, and sequelae of volume overload remain far too common under the current paradigm. Recent studies indicate that the mortality associated with volume overload is independent of hypertension, suggesting that if mortality is to be improved, then a measure of volume independent of blood pressure must be developed. Even when considered as an integrated whole, the clinical method is inaccurate at setting dry weight when compared to the use of assistive technologies. A recent secondary analysis of a randomized trial showed that relative plasma volume (RPV) slope is responsive to change in volume status and may be useful in guiding therapy for hypertension. The only large randomized trial to investigate the ability of an assistive technology to manage volume removal in hemodialysis patients is the Crit-Line Intradialytic Monitoring Benefit Study, which found harm associated with RPV monitoring. However, the design of this trial did not require the RPV group to actually receive this intervention. Assistive technologies offer an opportunity to improve on the subjective clinical exam for the setting of dry weight, but well designed and adequately powered clinical trials are needed.

AB - Despite advancements in dialysis therapy, the subjective clinical examination still remains the standard of care in managing volume removal in chronic dialysis. While there is no definitive trial establishing that dry weight management guided by an assistive technology is superior to the clinical method, there is ample evidence that there is a need for these technologies to be developed. Mortality, cardiovascular morbidity, and sequelae of volume overload remain far too common under the current paradigm. Recent studies indicate that the mortality associated with volume overload is independent of hypertension, suggesting that if mortality is to be improved, then a measure of volume independent of blood pressure must be developed. Even when considered as an integrated whole, the clinical method is inaccurate at setting dry weight when compared to the use of assistive technologies. A recent secondary analysis of a randomized trial showed that relative plasma volume (RPV) slope is responsive to change in volume status and may be useful in guiding therapy for hypertension. The only large randomized trial to investigate the ability of an assistive technology to manage volume removal in hemodialysis patients is the Crit-Line Intradialytic Monitoring Benefit Study, which found harm associated with RPV monitoring. However, the design of this trial did not require the RPV group to actually receive this intervention. Assistive technologies offer an opportunity to improve on the subjective clinical exam for the setting of dry weight, but well designed and adequately powered clinical trials are needed.

KW - Bioimpedance

KW - Blood pressure

KW - Dry weight

KW - End-stage renal disease

KW - Hemodialysis

KW - Hypertension

KW - Physical exam

KW - Relative plasma volume

KW - Volume status

UR - http://www.scopus.com/inward/record.url?scp=78651456853&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78651456853&partnerID=8YFLogxK

U2 - 10.1159/000321840

DO - 10.1159/000321840

M3 - Article

VL - 31

SP - 197

EP - 202

JO - Blood Purification

JF - Blood Purification

SN - 0253-5068

IS - 1-3

ER -