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Schoutteten MK, Lindeboom L, Brys A, Lanssens D, Smeets CJP, De Cannière H, De Moor B, Peeters J, Heylen L, Van Hoof C, Groenendaal W, Kooman JP, Vandervoort PM. Comparison of whole body versus thoracic bioimpedance in relation to ultrafiltration volume and systolic blood pressure during hemodialysis. J Appl Physiol (1985) 2023; 135:1330-1338. [PMID: 37767559 DOI: 10.1152/japplphysiol.00600.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
In contrast to whole body bioimpedance, which estimates fluid status at a single point in time, thoracic bioimpedance applied by a wearable device could enable continuous measurements. However, clinical experience with thoracic bioimpedance in patients on dialysis is limited. To test the reproducibility of whole body and thoracic bioimpedance measurements and to compare their relationship with hemodynamic changes during hemodialysis, these parameters were measured pre- and end-dialysis in 54 patients during two sessions. The resistance from both bioimpedance techniques was moderately reproducible between two dialysis sessions (intraclass correlations of pre- to end-dialysis whole body and thoracic resistance between session 1 and 2 were 0.711 [0.58-0.8] and 0.723 [0.6-0.81], respectively). There was a very high to high correlation between changes in ultrafiltration volume and changes in whole body thoracic resistance. Changes in systolic blood pressure negatively correlated to both bioimpedance techniques. Although the relationship between changes in ultrafiltration volume and changes in resistance was stronger for whole body bioimpedance, the relationship with changes in blood pressure was at least comparable for thoracic measurements. These results suggest that thoracic bioimpedance, measured by a wearable device, may serve as an interesting alternative to whole body measurements for continuous hemodynamic monitoring during hemodialysis.NEW & NOTEWORTHY We examined the role of whole body and thoracic bioimpedance in hemodynamic changes during hemodialysis. Whole body and thoracic bioimpedance signals were strongly related to ultrafiltration volume and moderately, negatively, to changes in blood pressure. This work supports the further development of a wearable device measuring thoracic bioimpedance longitudinally in patients on hemodialysis. As such, it may serve as an innovative tool for continuous hemodynamic monitoring during hemodialysis in hospital or in a home-based setting.
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Affiliation(s)
- Melanie K Schoutteten
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Health Research, imec the Netherlands, Eindhoven, The Netherlands
| | - Lucas Lindeboom
- Department of Health Research, imec the Netherlands, Eindhoven, The Netherlands
| | - Astrid Brys
- Division of Geriatrics, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dorien Lanssens
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Christophe J P Smeets
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Health Research, imec the Netherlands, Eindhoven, The Netherlands
| | - Hélène De Cannière
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Bart De Moor
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Nephrology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Jacques Peeters
- Department of Nephrology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Line Heylen
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Nephrology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Chris Van Hoof
- Imec Belgium, Leuven, Belgium
- Department of Electrical Engineering, Elektronische Circuits en Systemen, Katholieke Universiteit Leuven-ESAT, Leuven, Belgium
| | | | - Jeroen P Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Pieter M Vandervoort
- Faculty of Biomedical and Life Sciences, Limburg Clinical Research Center/Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Health Research, imec the Netherlands, Eindhoven, The Netherlands
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium
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Sugizaki CSA, Queiroz NP, Silva DM, Freitas ATVS, Costa NA, Peixoto MRG. Comparison of Bioelectrical Impedance Vector Analysis (BIVA) to 7-point Subjective Global Assessment for the diagnosis of malnutrition. J Bras Nefrol 2021; 44:171-178. [PMID: 34590669 PMCID: PMC9269190 DOI: 10.1590/2175-8239-jbn-2021-0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/31/2021] [Indexed: 01/07/2023] Open
Abstract
Introduction: Bioelectrical impedance vector analysis (BIVA) is a non-invasive and low-cost
strategy. The methods used to assess malnutrition in patients undergoing HD
are still a challenge. The aim of the present study was to compare BIVA to
7-Point Subjective Global Assessment (7-point SGA) to identify malnutrition.
We also investigated the sensitivity and specificity of the previously
proposed cutoffs point for BIVA parameters. Methods: Patients of both sexes, over 20 years of age, on HD treatment were included.
Anthropometric parameters, laboratory data, and bioelectrical impedance
analysis (BIA) were evaluated. Values of resistance (R) and reactance (Xc)
obtained by mono-frequency BIA were normalized to body height (H) to
generate a graph of the bioimpedance vector with the BIVA software. The
analysis of the area under the receiver operating curve ROC (AUC) was
performed. Results: Among the included 104 patients, the mean age was 51.70 (±15.10) years, and
52% were male. The BIVA had a sensitivity of 35% for diagnosing
malnutrition. The specificity of BIVA for identifying the well-nourished
patients was 85.7%. The diagnostic accuracy between the BIVA and 7-point SGA
was AUC=0.604; 95%CI 0.490-0.726, higher than the previously established
cutoff values (AUC=0.514; 95%CI: 0.369-0.631). The 95% confidence ellipses
did not overlap (p<0.05). Conclusion: Our study showed low accuracy of BIVA for diagnosing malnutrition using a
7-point SGA as a reference standard. However, it is a complementary method
for assessing nutritional status as it provides data on cellularity and
hydration, which are important aspects for the HD population.
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Affiliation(s)
- Clara S A Sugizaki
- Universidade Federal de Goiás, Faculdade de Nutrição, Programa de Pós-graduação Nutrição e Saúde, Goiânia, GO, Brasil
| | - Nayara P Queiroz
- Universidade Federal de Goiás, Faculdade de Nutrição, Programa de Pós-graduação Nutrição e Saúde, Goiânia, GO, Brasil
| | - Débora M Silva
- Universidade Federal de Goiás, Faculdade de Nutrição, Programa de Pós-graduação Nutrição e Saúde, Goiânia, GO, Brasil
| | - Ana T V S Freitas
- Universidade Federal de Goiás, Faculdade de Nutrição, Goiânia, GO, Brasil
| | - Nara A Costa
- Universidade Federal de Goiás, Faculdade de Nutrição, Goiânia, GO, Brasil
| | - Maria R G Peixoto
- Universidade Federal de Goiás, Faculdade de Nutrição, Goiânia, GO, Brasil
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Association of Drug Application and Hydration Status in Elderly Patients. Nutrients 2021; 13:nu13061929. [PMID: 34199738 PMCID: PMC8226953 DOI: 10.3390/nu13061929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
Due to multifactorial reasons, such as decreased thirst and decreased total body water, elderly patients are vulnerable to dehydration. Mild cognitive impairment (MCI) or dementia increase the risk of dehydration and, in turn, dehydration decreases cognitive performance. The study aims to identify and assess differences in hydration status, taking into account patients’ drug treatment and diseases, using bioelectrical impedance vector analysis (BIVA), thereby revealing unfavorable aspects of prognosis. 447 geriatric patients (241 women, 206 men) including information on medication and bioelectrical impedance analysis (BIA) were investigated, which allowed studying the association between 40 drugs and the hydration status. First, patients were divided into disease groups. Renal disease and diuretic treatment were significantly different in both sexes, whereas cardiovascular patients differed exclusively for females. Next, drug enrichment was examined in either hyperhydrated or dehydrated patients. Simvastatin, candesartan, bisoprolol, amlodipine, olmesartan, furosemide, torasemide, allopurinol, mirtazapine, pantoprazole, cholecalciferol, and resveratrol showed enrichment depending on hydration status. This study demonstrated that patients can be differentiated and stratified by BIVA, taking into account medication and disease associated with hydration status. Although patients diagnosed with MCI and therefore treated with resveratrol, BIVA still showed evaluated dehydration. This is unfavorable in terms of prognosis and requires special attention.
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Schotman JM, Hazeleger LR, van Borren MMGJ, Wetzels JFM, Kloke HJ, Reichert LJM, Doorenbos CJ, de Boer H. Optimal current frequency for the detection of changes in extracellular water in patients on hemodialysis by measurement of total body electrical resistance. Clin Nutr ESPEN 2021; 43:302-307. [PMID: 34024531 DOI: 10.1016/j.clnesp.2021.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/05/2021] [Accepted: 03/15/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS Measurement of total body electrical resistance (TBER) to an alternating current is useful to monitor extracellular water (ECW) in patients on hemodialysis (HD). Which current frequency is preferable is subject of ongoing debate. The aim of this study was to quantify the implications of TBER measurements at current frequencies ranging from 0 to 1000 kHz for ECW monitoring in patients on HD. METHODS Bioimpedance spectroscopy measurements were performed in 39 patients on HD using the Body Composition Monitor (BCM, Fresenius Medical Care). TBER data at 5, 50, 200, 500, and 1000 kHz were compared with the extrapolated TBER at 0 kHz (TBER0) assessed by Cole-Cole analysis. Sensitivity of each TBER configuration was evaluated at individual level, by assessment of the smallest ultrafiltration (UF) volume that induced a significant change in TBER, i.e. a change in TBER ≥ 2.7%. RESULTS TBER precision was very high for all frequencies, with coefficients of variation of 0.25%-0.28%. Baseline TBER decreased with increasing current frequency. TBER was 2.9% lower at 5 kHz (P < 0.001), 11.6% lower at 50 kHz, and up to 22.0% lower at 1000 kHz. This pattern is attributed to a progressive increase in intracellular current conduction at higher frequencies. Sensitivity to volume changes induced by UF also decreased with increasing current frequency. At 0 and 5 kHz, an UF volume ≤ 0.5 L was sufficient to induce a significant increase in TBER in 87% of patients. This decreased to 69% at higher frequencies. CONCLUSION ECW monitoring by TBER requires measurement at 5 kHz or less to ensure optimal performance.
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Affiliation(s)
- J M Schotman
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands.
| | - L R Hazeleger
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - M M G J van Borren
- Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, the Netherlands
| | - J F M Wetzels
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H J Kloke
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L J M Reichert
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - C J Doorenbos
- Department of Internal Medicine, Deventer Hospital, Deventer, the Netherlands
| | - H de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
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Schotman J, van Borren M, Wetzels J, Kloke H, Reichert L, Doorenbos CJ, de Boer H. Impact of diffusion, ultrafiltration, and posture on total body electrical resistance in patients on hemodialysis. J Appl Physiol (1985) 2021; 130:318-324. [PMID: 33211631 DOI: 10.1152/japplphysiol.00688.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Monitoring of hydration in patients on hemodialysis (HD) by currently available bioelectrical impedance analysis (BIA) methods is hampered by limited accuracy. This may be caused by changes in total body electrical resistance (TBER) that are induced by processes other than ultrafiltration (UF). To identify these sources of error, we examined the impact of UF, diffusion, and postural change (PC), separately. Extracellular TBER (TBERe) was measured by bioimpedance spectroscopy every 30 min in 23 patients on HD, for 2 h during diffusion-only (DO), followed by 2-h UF-only (UFO). The impact of PC from upright to semi-recumbent position was assessed by a 2-h TBERe measurement on the day after HD. TBERe increased by 23.5 ± 12.4 Ω (P < 0.001) during DO and by 40.0 ± 16.2 Ω (P < 0.001) during UFO. PC, evaluated on a separate day, was associated with an increase in TBERe of 27.6 ± 26.0 Ω (P < 0.001). TBERe changes during DO were mainly attributed to PC and to a lesser extent to electrolyte exchange. Extrapolation of the data to a conventional 4-h HD session indicates that about 32% of the total increase in TBERe is not related to UF. In conclusion, a significant part of the increase in TBER during HD is not related to UF but can be attributed to other processes such as the effects of PC and diffusion-related electrolyte exchange. These factors have to be taken into account when TBER-guided UF is considered.NEW & NOTEWORTHY Current BIA methods have limited accuracy in patients on HD. This may be related to the incorrect assumption that all changes in total body electrical resistance (TBER) are caused by changes in body water volumes. The present study indicates that two-thirds of the change in TBER during a conventional 4-h HD session can be attributed to fluid extraction, and that the remaining part is caused by other processes such as postural change and electrolyte exchange. This may cause volume prediction errors when not recognized.
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Affiliation(s)
- Jantine Schotman
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marcel van Borren
- Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jack Wetzels
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Heinrich Kloke
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Louis Reichert
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Hans de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
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Boksem E, Schotman JM, Joosten FBM, van Borren MMGJ, de Boer H. Prediction of total body electrical resistance normal values based on limb muscle thickness assessed by ultrasound. Eur J Clin Nutr 2021; 75:1267-1274. [PMID: 33462458 DOI: 10.1038/s41430-020-00837-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/10/2020] [Accepted: 12/07/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recently, a new model has been proposed to assess hydration in patients by measurement of total body electrical resistance (TBER), with results expressed in ohm rather than in liter body water. According to this approach, hydration is considered to be normal if TBER is within the normal range. As TBER is inversely related to the size of the limb muscle compartment, this relationship can be used to calculate the patient-specific TBER normal value (TBERnorm). The present study investigates whether the prediction of TBERnorm can be improved by the use of ultrasound (US) instead of anthropometrically derived parameters of limb muscularity. METHODS In total, 129 healthy subjects (60 men and 69 women) ranging in age from 18 to 75 yr, and in BMI from 17.4 to 52.0 kg/m2 were included in the study. Arm muscle cross-sectional area assessed by anthropometry (AMAcaliper) was compared with mean muscle thickness (MMT) of arm and leg assessed by B-mode US. RESULTS MMT correlated stronger with TBER than AMA, and reduced the standard error of the estimate (SEE) by 15% in men and by 26% in women. Muscularity was overestimated by AMAcaliper due to a systematic error directly proportional to subcutaneous fat layer thickness. The gender independent relation between MMT and TBERnorm is described by the equation: TBERnorm = 705-75.4⋅MMT (R2 = 0.85, SEE = 22.3 Ω/m, P < 0.001). CONCLUSIONS US-based measurement of limb muscularity provides a more precise prediction of TBERnorm, in particular in obese subjects, and is recommended as the method of choice.
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Affiliation(s)
- E Boksem
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - J M Schotman
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
| | - F B M Joosten
- Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - M M G J van Borren
- Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, The Netherlands
| | - H de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
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Schotman JM, van Borren MMGJ, Wetzels JFM, Kloke HJ, Reichert LJM, de Boer H. Sensitivity of total body electrical resistance measurements in detecting extracellular volume expansion induced by infusion of NaCl 0.9%. Eur J Clin Nutr 2020; 74:1638-1645. [DOI: 10.1038/s41430-020-0655-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 12/13/2022]
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Schotman J, van Borren M, Kooistra M, Doorenbos C, de Boer H. Corrigendum to ‘Towards personalized hydration assessment in patients, based on measurement of total body electrical resistance: Back to basics’ [Clin Nutr ESPEN 35C (2019) 116–122]. Clin Nutr ESPEN 2020; 36:172-173. [DOI: 10.1016/j.clnesp.2020.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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