Optimizing hemodialysis management using bioelectrical impedance analysis: emphasizing the significance of the phase angle.

Patients undergoing hemodialysis (HD) often experience complications, such as severe malnutrition, muscle wasting, and fluid overload, which significantly affect survival rates and quality of life. Accurate assessment and management of nutritional status and fluid retention are essential for improving patient outcomes. Bioelectrical impedance analysis (BIA), a noninvasive and practical tool, is increasingly used to assess body composition and fluid distribution in patients undergoing HD. The phase angle (PhA), a BIA parameter, reflects cellular integrity and serves as a reliable indicator of nutritional status and clinical prognosis. This review discusses the clinical utility of BIA in assessing nutritional status, fluid retention, and body composition in patients undergoing maintenance HD, with a particular focus on the PhA. The role of the PhA in predicting survival, frailty, sarcopenia, and erythropoiesis-stimulating agent resistance was explored. The application of personalized dry weight management guided by BIA has been proposed to optimize the care of patients undergoing HD. Despite limitations, including inter-device variability, lack of standardized cutoff values, and limited evidence, BIA represents a promising tool that may enhance clinical outcomes if integrated into routine clinical practice.