Acute renal injury improves survival rate through fluid management through bioelectrical impedance
Dec 16, 2024
A research team led by Kim Se-joong, a professor of kidney medicine at Seoul National University Bundang Hospital, has published a study that confirmed the possibility that body fluid management through Bioimpedance Analysis (BIA), well known as Inbody, can increase survival rates more accurately and effectively than conventional methods in patients with severe acute renal injury (AKI) undergoing continuous renal replacement therapy (CKRT).
Acute renal injury refers to a condition in which the balance between body fluids and electrolytes can no longer be maintained due to a rapid decline in renal function, and is treated with dialysis or continuous renal replacement therapy. Unlike dialysis, which removes waste for a short period of two to four hours, continuous renal replacement therapy is a method of purifying blood in place of damaged kidneys by continuously circulating blood in vitro for 24 hours.
In particular, patients with acute renal injury are prone to fluid excess, which increases the burden on the cardiovascular and lung and significantly increases the risk of death, so proper management of fluid has a significant impact on patient survival. When continuous renal replacement therapy is performed, the body fluid is managed based only on the patient's weight change and body fluid intake and discharge.
However, it is difficult to accurately reflect the actual water condition in the body, and there are limitations in effectively managing complex body fluid changes in intensive care patients. Accordingly, a technology that accurately identifies the patient's fluid condition and efficiently manages acute renal injury has been required.
A research team led by Kim Se-joong, a professor of kidney medicine at Seoul National University Bundang Hospital, wanted to see if managing body fluids using bioelectrical impedance analysis (BIA) technology can effectively control body fluid balance and increase survival rates in patients with acute kidney injury who undergo continuous renal replacement therapy. Bioelectrical impedance analysis is a technology that measures the total content of body fluids in tissues by passing electric current through the human body, and has been widely used to measure muscles and fat. Recently, the use of moisture measurement using this technology has emerged, but related clinical studies are insufficient.
The research team conducted a randomized controlled clinical study of 208 patients who needed continuous renal replacement therapy due to severe acute renal injury at eight major hospitals in Korea between July 2017 and July 2020. The effective achievement of estimated equilibrium and mortality were evaluated, and the safety and side effects of the bioelectrical impedance analysis group were checked by dividing it into a group (control) that manages body fluids based only on the patient's weight change and body fluid intake and discharge.
As a result of the study, it was confirmed that continuous renal replacement therapy based on bioelectrical impedance analysis plays an important role in effectively achieving the estimated equilibrium state. In the bioelectrical impedance analysis group, fluid reached equilibrium more rapidly within the first 24 hours of treatment, meaning that it could be a useful tool for accelerating fluid removal early in continuous renal replacement therapy.
In addition, the 28-day mortality rate of the bioelectrical impedance analysis group was 37%, which was lower than that of the control group, 52%. This suggests the possibility that proper fluid volume control may improve patient mortality. In addition, there was no significant difference between the two groups in the frequency of hypotension and the frequency of drug use required to stabilize blood pressure, confirming the safety of continuous renal replacement therapy using bioelectrical impedance.
The results of this study are significant as they confirm that using bioelectrical impedance analysis technology in continuous renal replacement therapy is an effective tool to manage excess fluid conditions and improve short-term survival rates.
Professor Kim Se-joong said, "This study is an important achievement that uses innovative new technologies in the field of kidney disease to set new standards for the treatment of severe disease, and will contribute to establishing important clinical guidelines for managing fluid excess of continuous renal replacement therapy in the future. We plan to further explore ways to utilize bioelectrical impedance technology through further verification of the speed and method of fluid control in the early stages and research to support improvement of mortality in the future."
The study was conducted as a project to support clinical trials of medical devices by the Korea Health Industry Promotion Agency and was published in the Clinical Journal of the American Society of Nephrology. 논문명은 'Bioimpedance-Guided Fluid Removal in Continuous Kidney Replacement Therapy: The VENUS Randomized Clinical Trial'이다.
Acute renal injury refers to a condition in which the balance between body fluids and electrolytes can no longer be maintained due to a rapid decline in renal function, and is treated with dialysis or continuous renal replacement therapy. Unlike dialysis, which removes waste for a short period of two to four hours, continuous renal replacement therapy is a method of purifying blood in place of damaged kidneys by continuously circulating blood in vitro for 24 hours.
In particular, patients with acute renal injury are prone to fluid excess, which increases the burden on the cardiovascular and lung and significantly increases the risk of death, so proper management of fluid has a significant impact on patient survival. When continuous renal replacement therapy is performed, the body fluid is managed based only on the patient's weight change and body fluid intake and discharge.
However, it is difficult to accurately reflect the actual water condition in the body, and there are limitations in effectively managing complex body fluid changes in intensive care patients. Accordingly, a technology that accurately identifies the patient's fluid condition and efficiently manages acute renal injury has been required.
A research team led by Kim Se-joong, a professor of kidney medicine at Seoul National University Bundang Hospital, wanted to see if managing body fluids using bioelectrical impedance analysis (BIA) technology can effectively control body fluid balance and increase survival rates in patients with acute kidney injury who undergo continuous renal replacement therapy. Bioelectrical impedance analysis is a technology that measures the total content of body fluids in tissues by passing electric current through the human body, and has been widely used to measure muscles and fat. Recently, the use of moisture measurement using this technology has emerged, but related clinical studies are insufficient.
The research team conducted a randomized controlled clinical study of 208 patients who needed continuous renal replacement therapy due to severe acute renal injury at eight major hospitals in Korea between July 2017 and July 2020. The effective achievement of estimated equilibrium and mortality were evaluated, and the safety and side effects of the bioelectrical impedance analysis group were checked by dividing it into a group (control) that manages body fluids based only on the patient's weight change and body fluid intake and discharge.
As a result of the study, it was confirmed that continuous renal replacement therapy based on bioelectrical impedance analysis plays an important role in effectively achieving the estimated equilibrium state. In the bioelectrical impedance analysis group, fluid reached equilibrium more rapidly within the first 24 hours of treatment, meaning that it could be a useful tool for accelerating fluid removal early in continuous renal replacement therapy.
In addition, the 28-day mortality rate of the bioelectrical impedance analysis group was 37%, which was lower than that of the control group, 52%. This suggests the possibility that proper fluid volume control may improve patient mortality. In addition, there was no significant difference between the two groups in the frequency of hypotension and the frequency of drug use required to stabilize blood pressure, confirming the safety of continuous renal replacement therapy using bioelectrical impedance.
The results of this study are significant as they confirm that using bioelectrical impedance analysis technology in continuous renal replacement therapy is an effective tool to manage excess fluid conditions and improve short-term survival rates.
Professor Kim Se-joong said, "This study is an important achievement that uses innovative new technologies in the field of kidney disease to set new standards for the treatment of severe disease, and will contribute to establishing important clinical guidelines for managing fluid excess of continuous renal replacement therapy in the future. We plan to further explore ways to utilize bioelectrical impedance technology through further verification of the speed and method of fluid control in the early stages and research to support improvement of mortality in the future."
The study was conducted as a project to support clinical trials of medical devices by the Korea Health Industry Promotion Agency and was published in the Clinical Journal of the American Society of Nephrology. 논문명은 'Bioimpedance-Guided Fluid Removal in Continuous Kidney Replacement Therapy: The VENUS Randomized Clinical Trial'이다.
|
bellho@sportschosun.com
