Response to the Letter to the Editor - Regarding Efficacy and Safety of Technology-Guided Dry Weight Adjustment Among Dialysis Patients - Author Response

Sep 30, 2026

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Response letter addressing critiques of a recent meta-analysis on technology-guided dry weight adjustment among dialysis patients. The authors clarify that Table 2 reports total patients per group rather than event counts, and discuss mortality findings as likely influenced by multifactorial dialysis-related causes. They highlight cardiovascular benefits, emphasizing pulse wave velocity improvements and corresponding reductions in cardiovascular event risk, supported by absolute risk reduction and number needed to treat. The response agrees that clinical assessment remains standard while noting subclinical volume overload and encouraging further bioimpedance-focused research with extended follow-up.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Letter to the Editor

Clarification of Table 2 counts

Mortality interpretation and follow-up suggestions

Cardiovascular outcomes and clinical implications

Conclusion and call for further research

Correspondence LETTER TO THE EDITOR Response to the Letter to the Editor Regarding “The Efficacy and Safety of Technology-Guided Dry Weight Adjustment Among Dialysis Patients: A Meta-Analysis of Randomized Controlled Trials” To the Editor: We appreciate the thoughtful comments provided in the letter to the editor regarding our recent study,“The Efficacy and Safety of Technology-Guided Dry Weight Adjustment Among Dialysis Patients: A Meta-analysis of Randomized Controlled Trials”1 The letter pointed out that Table 2 shows a higher number of deaths (1,741 vs 1,707) and cardiovascular events (1,090 vs 1,065) in the intervention group compared with the control group. We would like to clarify that the numbers in Table 2 refer to the total number of patients per group, not the number of events. The crude event data from each included study arepresented in Figs 3 and 41 and summarized below in Table 1. We acknowledge that the effect of technology-assisted dry weight adjustment on mortality may not be statistically significant (relative risk, 0. 82; 95% confidence interval, 0.63-1. 07) . This likely reflects the multifactorial nature of mortality in dialysis patients, with contributors such as infections playing substantial roles.2 , 3 Furthermore, as you pointed out, extended follow-up periods in future well-designed studies—especially those focusing on bioimpedance analysis, which showed the most promising results in our subgroup analysis—may help to better determine its true impact. Regarding cardiovascular outcomes, our study demonstrated a significant improvement in cardiovascular parameters—particularly pulse wave velocity (weighted mean difference −2.43 m/s; 95% confidence interval, −4.64 to −0 . 21)—which may contribute toa reduction in cardiovascular events (relative risk, 0. 79; 95% confidence interval, 0.71-0. 88) . An absolute risk reduction of 5. 7% and a number needed to treat of 17.5 underscore the potential benefits of this intervention. We totally agree that clinical assessment remains the standard approach for determining dry weight in dialysis patients. However, some individuals may experience subclinical volume overload without obvious clinical signs. In such cases, these instruments could play a valuable role in identifying and managing this hidden burden in clinical practice. We appreciate this opportunity to discuss these critical issues and concur that additional well-designed research focusing on bioimpedance analysis-guided dry weight adjustment with an extended follow-up period would be beneficial. We strongly encourage collaborative initiatives to bridge these gaps and refine volume management strategies for these high cardiovascular risk populations. Wannasit Wathanavasin, MD, MSc, Charat Thongprayoon, MD, and Wisit Cheungpasitporn, MD ARTICLE INFORMATION Authors’ Affiliations: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota (WW, CT, WC); and Nephrology unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand (WW) . Address for Correspondence: Wannasit Wathanavasin, MD, MSc, Nephrology unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand. [Email:](Email: Wannasit.medical@mfu.ac.th)[ Wannasit.medical@mfu.ac.th](Email: Wannasit.medical@mfu.ac.th) Support: None. Financial Disclosure: The authors declare that they have no relevant competing interests. Peer Review: Received September 3, 2025. Evaluated by the Editor in Chief. Accepted in revised form September 4, 2025. Publication Information: © 2025 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This isan open access article under the CC BY-NC-ND license ([http://](http://)[ ](http://)[creativecommons.org/licenses/by-nc-nd/4.0/](creativecommons.org/licenses/by-nc-nd/4.0/)). Published online December 9, 2025 with doi

FAQs

What clarification do the authors make about Table 2?

The authors clarify that Table 2 reflects the total number of patients per group, not the number of events.

How do the authors interpret the mortality results?

They acknowledge that the mortality effect may not be statistically significant and suggest this likely relates to the multifactorial causes of mortality in dialysis patients, including infections.

What cardiovascular outcomes does the study report as improved?

The authors report a significant improvement in cardiovascular parameters, especially pulse wave velocity, which may contribute to a reduction in cardiovascular events.

Sep 30, 2026

Uploaded by Finn