Multiple frequency bio-impedance 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
Chronic kidney disease can lead to kidney failure and the need for waste products and excess fluid to be removed from the blood by a process called dialysis. In people having dialysis, it is important to monitor the amount of fluid being removed, as removing too much, or not enough, fluid, can cause other health problems during dialysis or between dialysis sessions. Assessing the fluid levels has traditionally been done by medical staff using their experience and clinical judgement but this can be unreliable. In recent years, a type of technical device has been introduced to estimate a person’s fluid (hydration) status, and help determine the amount of fluid to remove during a dialysis session. These devices work by sending painless electrical currents through the body via electrodes attached to certain parts of it (e.g. hand and foot). Based on the impedance offered by the body to currents of different electrical frequency, an algorithm is used to compute a person’s body composition (i.e. lean tissue, fat tissue, intracellular and extracellular water). In turn, this data can be used to estimate the amount of fluid that should be removed during dialysis in order to achieve normal levels of hydration. This modelling systematic review and modelling study assessed the clinical and cost-effectiveness of the using multiple frequency bio-impedance devices to guide fluid management decision in patients on dialysis. While the cost-effectiveness modelling suggested potential for such devices to prove cost-effective, the limited evidence on clinically relevant outcomes lead to a high degree of uncertainty in the findings.
Outcome and translation
Based on consideration of the report and consultation comments, the NICE diagnostics committee concluded that “there is currently not enough evidence to recommend the routine adoption of the BCM – Body Composition Monitor to guide fluid management in people with chronic kidney disease having dialysis in the NHS”. The committee recommended further research is to assess effects on clinical outcomes: https://www.nice.org.uk/guidance/dg29
This review is registered with PROSPERO International prospective register of systematic reviews: PROSPERO 2016:CRD42016041785
External collaborators: M. Brazzelli, M. Cruickshank (HSRU, University of Aberdeen), A. Marks (Other Applied Health Sciences, University of Aberdeen).
Scotland, G., Cruickshank, M., Jacobsen, E., Cooper, D., Fraser, C., Shimonovich, M., Marks, A. and Brazzelli, M. (2018) 'Multiple-frequency bioimpedance devices for fluid management in people with chronic kidney disease receiving dialysis: a systematic review and economic evaluation', Health Technology Assessment, 22(1).