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ABSTRACT: Despite technical and pharmacological improvements achieved over the past years, long-term prognosis of chronic kidney disease (CKD) patients undergoing hemodialysis (HD) is still rather poor. Cardiovascular disease (CVD) is the leading cause of both morbidity and mortality in these populations. Chronic volume overload is omnipresent in CKD patients on HD, and it leads to hypertension, left ventricular hypertrophy, and increased cardiovascular morbidity and mortality. On the other hand, volume depletion also has deleterious consequences such as intradialytic hypotension, increased risk for falls, and mortality. It is therefore crucial to accurately assess and maintain the optimal volume status of HD patients. The presence of volume overload can affect the utility of anthropometry in diagnosing undernutrition in end-stage renal disease. To refine body composition (BC) estimation, still mostly done by based on clinical signs, bioimpedance technology (BT) has been developed in the last 2 decades. BT expresses bodyweight regarding lean tissue mass and fat tissue mass independent of hydration status. Fluid status and BC defined by all types of BT proved useful as predictors of mortality risk in CKD patients and can be used for longitudinal analysis in this population. However, recently developed bioimpedance spectroscopy (BIS) technology using a powerful multinational cohort of HD patients undergoing routine BC and fluid assessments has been the most important advance for BT use for this population. In conclusion, the main achievement of BT for CKD patients is the mass of accumulated evidence associating suboptimal handling of fluids to outcomes beyond the classical parameters of dialysis adequacy. Implementation of BT as a routine bedside clinical tool in HD patients should be considered for helping the health team in decision-making. This review analyzes: 1) The benefits and limitations of bioimpedance applied in CKD patients; 2) How the changes in body composition and fluid status defined by impedancometry affect outcomes in this population, and 3) Future applications of bioimpedance technology in clinical settings.

Keywords: Body Fluid Compartments, Electric Impedance, malnutrition, Renal Insufficiency, Chronic