Multiple frequency bioimpedance devices (BCM - Body Composition Monitor, BioScan 920-II, BioScan touch i8, InBody S10 and MultiScan 5000) for fluid management in people with chronic kidney disease having dialysis

Bioimpedance devices are a technology based on passing a bioelectrical current through the body in order to estimate the body fluid volume by the amount of resistance the current endures in the body tissues.1 The bioelectrical current used in these devices can have spectral or multi-bioelectrical frequencies.1, 2 Multiple frequency bioimpedance devices are used to monitor the hydration status of people with chronic kidney disease who are treated with either haemodialysis or peritoneal dialysis. The information provided by the technology can be used to guide how much fluid to remove during dialysis. If too little or too much fluid is removed during dialysis this will lead to underhydration or overhydration (e.g. fluid overload). Short-term complications of fluid overload include oedema of the hands, feet and face, and fluid retention in the lungs (pulmonary oedema), causing shortness of breath. In contrast, short-term complications of underhydration may include cramps, dizziness and tiredness. Long-term fluid imbalance can result in poor blood pressure control, leading to heart disease, further reductions in kidney function and increased mortality. Fluid overload in people receiving dialysis can also cause ventricular hypertrophy which increases the risk of heart attack, stroke and arrhythmia. Multiple frequency bioimpedance devices aim to improve estimates of the amount of fluid to remove during dialysis, which may reduce complications associated with fluid overload or underhydration. Potential benefits of reduced fluid overload could include reduced use of antihypertensive medicine, reduced numbers of hypertensive episodes and reduced risk of cardiovascular complications and death. Potential benefits of reducing systematic underhydration could include greater preservation of renal function, reduced numbers of hypotensive episodes and a reduction in symptoms such as cramps and post-dialysis fatigue. Further benefits may include reduced hospital admission arising from overhydration and underhydration, and improved quality of life for people with chronic kidney disease (CKD). The purpose of this assessment is to review the current evidence on the clinical effectiveness and cost-effectiveness of multiple frequency bioimpedance devices for the fluid management of people with chronic kidney disease who are treated with haemodialysis or peritoneal dialysis.