Bioelectrical Impedance in Pediatric Dialysis: Clinical Applications, Limitations, and Opportunities

BACKGROUND: Optimizing fluid and nutritional management is a cornerstone of care for children with end-stage kidney disease on dialysis. Inaccurate assessment of hydration status contributes to hypertension, fluid overload, and increased cardiovascular risk, while masking important changes in muscle and fat compartments that affect growth and long-term outcomes. Bioelectrical impedance analysis (BIA) offers clinicians a noninvasive, rapid, and practical tool to support decision-making in this setting. AIMS: This review aims to provide clinicians with a practical framework for the use of BIA in pediatric dialysis, including its clinical applications, limitations, and opportunities for integration into routine care. MATERIALS AND METHODS: A narrative review of the literature was conducted, and findings were synthesized focusing on the principles of BIA, device technologies, and clinical studies evaluating its use in pediatric dialysis populations. Emphasis was placed on studies addressing fluid assessment, body composition, and clinical implementation. Adult literature was included where pediatric literature was lacking. RESULTS: Available evidence suggests BIA can provide useful estimates of total body water, fat mass, and lean tissue that may support ultrafiltration strategies, nutritional assessment, and longitudinal monitoring. Key limitations include variability related to growth, delayed maturation, obesity, malnutrition, and reliance on adult-derived prediction equations. Current evidence supports BIA as an adjunctive tool integrated with clinical assessment rather than a standalone measure. DISCUSSION: BIA may enhance individualized fluid and nutritional management when interpreted within the clinical context and standardized measurement protocols. Broader implementation requires awareness of pediatric-specific limitations, interdisciplinary interpretation, and cautious use of device-derived estimates. CONCLUSION: BIA is a practical adjunct for pediatric dialysis care with potential to improve fluid management and nutritional monitoring. Pediatric-specific validation studies, standardized protocols, and integration with clinical outcomes is needed to optimize its utility.