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 are presented in Figs 3 and 41 and summarized below in Table 1.
Table 1.
Summary of Crude Rates of Mortality and Cardiovascular Events in Each Group.
| Outcomes | Intervention (Event Rate) | Control (No.) | Absolute Risk Reduction | Relative Risk (95% CI) |
|---|---|---|---|---|
| Mortality | 176/1,741 (10.1%) | 210/1,707 (12.3%) | 2.2% | 0.82 (0.63-1.07) |
| Cardiovascular events | 205/1,090 (18.8%) | 261/1,065 (24.5%) | 5.7% | 0.79 (0.71-0.88) |
Abbreviations: CI, confidence interval; No., number.
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 to a 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.
Article Information
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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.
References
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