The Efficacy and Safety of Technology-Guided Dry Weight Adjustment Among Dialysis Patients: A Meta-analysis of Randomized Controlled Trials.

Rationale & Objective: Recently, various instrumental techniques adjunct to standard clinical evaluation have been used to improve fluid balance and guide dry weight adjustments in dialysis populations. We aimed to explore the efficacy and safety of using technology-guided dry weight adjustment among dialysis patients. Study Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). The search was conducted in PubMed, Scopus, and Cochrane Central Register of Controlled Trials for relevant RCTs published until April 28, 2024. Setting & Participants: Adult patients with kidney failure with replacement therapy. Exposure: Studies with patients receiving technology-guided dry weight adjustments. Outcomes: Studies were selected if they reported at least 1 outcome of interest (eg, mortality, cardiovascular [CV] events, hospitalization, intradialytic hypotension, hypovolemic events, cardiac arrhythmia, or vascular access problems). Analytical Approach: Random-effects meta-analyses were conducted, with risk of bias within studies assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. Results: A total of 21 RCTs involving 4,239 dialysis patients were analyzed. The meta-analysis revealed that the incorporating technology-guided dry weight adjustment not only was associated with a significant 21% reduction in CV events (relative risk, 0.79; 95% confidence interval [CI], 0.71-0.88) but also resulted in a significant 9% increase in muscle cramps (rate ratio, 1.09; 95% CI, 1.02-1.16). In a subgroup analysis, using bioelectrical impedance analysis was associated with a significant reduction in mortality (relative risk, 0.67; 95% CI, 0.51-0.89). In addition, the intervention led to a significant reduction in pulse wave velocity (mean difference, -2.43 m/s; 95% CI, -4.64 to -0.21). Limitations: Large number of studies with some concerns or a high risk of bias. Conclusions: Technology-guided strategies for dry weight adjustment significantly reduce CV events and may lower all-cause mortality in dialysis patients. These benefits are particularly evident with bioelectrical impedance analysis--guided interventions. Nonetheless, clinicians should be aware of a modestly increased risk of muscle cramps.