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BioImpedance Spectroscopy To maintain Renal Output: the BISTRO Trial
Safe People
Keele University
Safe Projects
ILD65
Historically, ‘adequate’ dialysis has been measured by testing the levels of small molecules such as urea and creatinine. Little attention has been paid to an alternative approach, of optimising residual kidney function for as long as possible after commencing treatment. The maintenance of residual kidney function in dialysis patients is associated with improved survival. Other benefits include improved wellbeing, better quality of life and less need to remove high fluid volumes during dialysis. There is a growing body of evidence that poorly regulated fluid volume is associated with poor survival. Bioimpedance (BI) devices can give an objective assessment of a person's fluid status which, when used with clinical assessment, may help make decisions about the amount of fluid to remove in dialysis. BISTRO is a prospective, multicentre randomised controlled trial to determine if incorporation of bioimpedance into dialysis reduces loss of residual kidney function, with the potential to improve dialysis related symptoms, hospitalisation and survival. Of 54,000 people in the UK treated with kidney replacement therapies, 24,000 receive centre-based haemodialysis (HD) at an annual tariff of £24,000 excluding additional costs such as travel, drugs, access procedures and inpatient episodes. Bio-impedance (BI) has the potential to enhance the productivity of HD care by helping clinicians make appropriate and safe treatment decisions. Preservation of residual kidney function is associated with superior outcomes for HD patients across a number of domains and BISTRO is the first substantial trial to investigate this. BI also has potential to prevent premature death, improve outcomes by addressing cardiovascular risk, blood pressure and avoidance of acute illness episodes, to enhance the quality of life for people on dialysis, and contribute to a more positive patient experience.
04/06/2020