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Lee S, Battumur B, Lee JE, Park SH, Choi YJ, Kang DO, Park EJ, Lee DI, Choi JY, Roh SY, Na JO, Choi CU, Kim JW, Rha SW, Park CG, Yong HS, Yang Z, Kim EJ. Assessing lung fluid status using noninvasive bioelectrical impedance analysis in patients with acute heart failure: A pilot study. Int J Cardiol 2024; 409:132205. [PMID: 38795974 DOI: 10.1016/j.ijcard.2024.132205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/14/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Outpatient monitoring of pulmonary congestion in heart failure (HF) patients may reduce hospitalization rates. This study tested the feasibility of non-invasive high-frequency bioelectrical impedance analysis (HF-BIA) for estimating lung fluid status. METHODS This prospective study included 70 participants: 50 with acute HF (HF group) and 20 without HF (control group). All participants underwent a supine chest CT scan to measure lung fluid content with lung density analysis software. Concurrently, direct segmental multi-frequency BIA was performed to assess the edema index (EI) of the trunk, entire body, and extremities. RESULTS The correlation coefficients between lung fluid content and EI measured using HF-BIA were r = 0.566 (p < 0.001) and r = 0.550 (p < 0.001) for the trunk and whole body, respectively. In the HF group, the trunk EI (0.402 ± 0.015) and whole body EI (0.402 ± 0.016) were significantly higher than those of the control group (trunk EI, 0.383 ± 0.007; whole body EI, 0.383 ± 0.007; all p < 0.001). The lung fluid content was significantly higher in the HF than that in the control group (23.7 ± 5.3 vs. 15.5 ± 2.8%, p < 0.001). The log value of NT pro-BNP was significantly correlated with trunk EI (r = 0.688, p < 0.001) and whole-body EI (r = 0.675, p < 0.001) measured by HF-BIA, and the lung fluid content analyzed by CT (r = 0.686, p < 0.001). CONCLUSIONS BIA-based EI measurements of the trunk and whole body significantly correlated with lung fluid content and NT pro-BNP levels. Non-invasive BIA could be a promising screening tool for lung fluid status monitoring in acute HF patients.
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Affiliation(s)
- Sunki Lee
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Byambakhand Battumur
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Ji Eun Lee
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Soo Hyung Park
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - You-Jung Choi
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Dong Oh Kang
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Eun Jin Park
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Dae-In Lee
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jah Yeon Choi
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Seung Young Roh
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jin Oh Na
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jin Won Kim
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Seung Woon Rha
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Chang Gyu Park
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Zepa Yang
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Eung Ju Kim
- Cardiovascular Center, Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea.
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Wang Y, Ma W, Pu J, Chen F. Interrelationships between sarcopenia, bone turnover markers and low bone mineral density in patients on hemodialysis. Ren Fail 2023; 45:2200846. [PMID: 37122165 PMCID: PMC10134952 DOI: 10.1080/0886022x.2023.2200846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Hemodialysis (HD) patients are at risk for sarcopenia (SP) and bone loss, which may impact falls and bone fragility and lead to poor prognosis. Patients with HD and those with osteoporosis (OP) are still underdiagnosed and untreated. The aims of the present study were to evaluate the factors that affect bone mineral density (BMD) loss in HD patients, and explore traditional and novel approaches to manage chronic kidney disease-mineral-bone disorder (CKD-MBD). METHODS Patients who underwent regular HD at the First Affiliated Hospital of Soochow University were retrospectively evaluated. According to the WHO osteoporosis criteria, patients were categorized into three groups: normal BMD, osteopenia, and osteoporosis. Demographic and clinical data, skeletal muscle mass, and bone turnover markers(BTM) were compared between the three groups. The correlation between bone density and muscle mass was calculated, and related risk factors were analyzed. RESULTS This study enrolled 130 HD patients, 36 patients were diagnosed with sarcopenia (27.7%), 44 patients were diagnosed with osteopenia (33.8%), 19 patients were diagnosed with osteoporosis (14.6%), and 23 patients were diagnosed with osteosarcopenia (17.7%). The SMI was positively correlated with the BMD of the lumbar spine (r = 0.23, p < 0.01) and femoral neck (r = 0.22, p < 0.05). In ordinal logistic regression analysis, the odds ratio (OR) for low BMD was high for patients with sarcopenia (OR = 5.894, 95% CI 1.592-21.830, p < 0.01), older age (OR = 1.095, 95% CI 1.041-1.153, p < 0.001), higher TRACP-5b levels (OR = 1.597, 95% CI 1.230-2.072, p < 0.01), and lower 25-OH vitamin D levels (OR = 0.631, 95% CI 0.544-0.733, p < 0.001). CONCLUSION The preservation of skeletal muscle mass could be important to prevent a BMD decrease in HD patients. Adequate intake of vitamin D and control of TRACP-5b levels will help reduce the occurrence and progression of osteopenia/sarcopenia in HD patients.
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Affiliation(s)
- Yilin Wang
- The Blood Purification Center, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Wenxia Ma
- Quality Management Dept, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Jianhong Pu
- The Center of Health Management, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Fengling Chen
- The Blood Purification Center, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
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Yajima T, Yajima K. Association of extracellular water/total body water ratio with protein-energy wasting and mortality in patients on hemodialysis. Sci Rep 2023; 13:14257. [PMID: 37652929 PMCID: PMC10471676 DOI: 10.1038/s41598-023-41131-3] [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: 03/04/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
Bioimpedance analysis-assessed extracellular water/total body water (ECW/TBW) ratio may be a marker for mortality and poor nutritional status in hemodialysis patients. In 193 maintenance hemodialysis patients, we retrospectively investigated the relationships among ECW/TBW ratio, mortality, and protein-energy wasting (PEW). Four components-body mass index, normalized protein catabolic rate, normalized serum creatinine level, and serum albumin level-constitute the simple PEW score; this score was calculated based on the positive number of items concerning malnutrition among these four components. A score ≥ 3 indicated PEW. Patients were stratified by an ECW/TBW ratio cut-off value (0.40) and by PEW versus non-PEW status. The simple PEW score, cardiothoracic ratio, and log-transformed C-reactive protein level were independently correlated with the ECW/TBW ratio. Eighty-four patients died during follow-up (median 4.3 years). After adjustments for sex, age, hemodialysis vintage, histories of cardiovascular events and diabetes, and C-reactive protein level, a higher ECW/TBW ratio and PEW were independently related to elevated risks of all-cause death. Adding the ECW/TBW ratio to a baseline risk model including PEW significantly increased C-statistics from 0.788 to 0.835. In conclusion, the ECW/TBW ratio may be an indicator of PEW and may be a predictor of death even accounting for PEW, in hemodialysis patients.
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Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Hashima Gun, Gifu, 501-6062, Japan.
| | - Kumiko Yajima
- Department of Internal Medicine, Matsunami General Hospital, Hashima Gun, Gifu, 501-6062, Japan
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Hori T, Nakamura S, Yamagami H, Yasui S, Hosoki M, Hara T, Mitsui Y, Masuda S, Kurahashi K, Yoshida S, Harada T, Kuroda A, Otoda T, Yuasa T, Endo I, Matsuhisa M, Abe M, Aihara KI. Phase angle and extracellular water-to-total body water ratio estimated by bioelectrical impedance analysis are associated with levels of hemoglobin and hematocrit in patients with diabetes. Heliyon 2023; 9:e14724. [PMID: 37057050 PMCID: PMC10089257 DOI: 10.1016/j.heliyon.2023.e14724] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 03/28/2023] Open
Abstract
Background Anemia is one of the common complications of diabetes and is associated with mortality. Phase angle (PhA), ratio of extracellular water to total body water (ECW/TBW) and skeletal muscle mass index (SMI) estimated by bioelectrical impedance analysis (BIA) have been used as prognostic indicators for various chronic diseases and frailty. We aimed to clarify the clinical significance of PhA, ECW/TBW and SMI for anemia in patients with diabetes. Materials and methods The values of PhA, ECW/TBW and SMI were estimated by a portable BIA device and blood samples were collected in 371 Japanese patients with diabetes. The relationships of PhA, ECW/TBW and SMI with hemoglobin (Hgb) and hematocrit (Hct) were statistically evaluated. Results In simple linear regression analysis, PhA and SMI were positively correlated with Hgb and Hct levels in total subjects, male subjects and female subjects. In contrast, ECW/TBW was negatively correlated with Hgb and Hct levels regardless of sex. Multivariate regression analysis showed that both PhA and ECW/TBW but not SMI independently contributed to Hgb and Hct levels after adjustment of clinical confounding factors in both males and females. Conclusions PhA and ECW/TBW but not SMI were associated with levels of Hgb and Hct in patients with diabetes. Therefore, aberrant values of PhA and ECW/TBW suggest a risk of anemia in diabetic patients.
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Cheng L, Chang L, Tian R, Zhou J, Luo F, Zhang H. The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis. Ren Fail 2022; 44:1192-1200. [PMID: 35856161 PMCID: PMC9318232 DOI: 10.1080/0886022x.2022.2095287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is becoming increasingly evident that the accurate assessment of fluid
status is critical to ensure optimal care in patients undergoing
hemodialysis (HD). Various fluid parameters, including
overhydration (OH) and overhydration/extracellular water
(OH/ECW%), which can be obtained using a
bioimpedance spectroscopy device have been used to indicate the hydration
status in such patients. This study aimed to explore the effect of these
fluid parameters on cardiovascular events and determine which parameter was
a better predictor of cardiovascular events (CVEs). Methods A total of 227 patients who underwent HD at the Hangzhou Hospital of
Traditional Chinese Medicine were enrolled in this prospective study between
December 2017 and August 2018. Clinical data were collected, and the fluid
status of patients was assessed using a body composition monitor. The
patients were followed up until December 2020. The primary outcomes were
CVEs. The association between fluid parameters and CVEs was analyzed using
Cox proportional hazards models. The areas under the curve
(AUCs) of receiver operating characteristic analysis and
improvement in the global chi-squared value were used to compare the
predictive values of fluid parameters for CVEs. Results During a median follow-up of 31 months, 66 CVEs were recorded. The
patients with a higher absolute hydration index (OH) and a
relative hydration index (OH/ECW%) exhibited an
increased risk of developing CVEs. After adjusting for confounding factors,
both OH [hazard ratio (HR) 1.279 per L, 95%
confidence interval (CI) 1.047–1.562;
p = 0.016] and OH/ECW%
(HR 1.061 per %, 95% CI 1.017–1.108;
p = 0.006) were
independently associated with CVEs. The predictive ability of the absolute
hydration index was superior to the relative hydration index based on AUC
calculations for CVEs. Furthermore, a greater change in
χ2 in predicting CVEs was noted
for the absolute hydration index. Conclusions Both absolute hydration index and relative hydration index were found to be
independent predictors of CVEs in univariate and multivariate analyses.
Furthermore, the absolute hydration index had a better additive predictive
value than the relative hydration index in predicting CVEs.
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Affiliation(s)
- Linghong Cheng
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Liyang Chang
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rongrong Tian
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jianfang Zhou
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fenxia Luo
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hongmei Zhang
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Seto Y, Kimura M, Matsunaga T, Miyasita E, Kanno Y. Long-term body composition changes in patients undergoing hemodialysis: a single-center retrospective study. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patients undergoing dialysis experience substantial decreases in muscle mass and functional muscle weakness. Muscle mass loss in patients undergoing hemodialysis is an independent predictor of survival, so muscle mass maintenance is essential for continued hemodialysis. This study examined longitudinal changes in the body composition of patients undergoing hemodialysis in different dialysis periods.
Methods
We retrospectively analyzed body composition measurements obtained by bioelectrical impedance analysis (BIA) using the same measuring instrument. The dialysis periods were 1–10 years from the start of hemodialysis for group A (n = 25), 10–20 years for group B (n = 22), and 20–30 years for group C (n = 9). The initial and final measurements of each group were compared. Furthermore, the nutritional status based on the inflammation and nutritional indicators obtained during the measurement period of each group was examined.
Results
Muscle mass did not significantly decrease in groups A and B but did decrease in group C (P < 0.05). In all groups, the extracellular water-to-total body water ratio (ECW/TBW) significantly increased (P < 0.001). C-reactive protein in groups A and B increased; however, the median initial and final values were < 0.2 mg/dL, and no changes were observed in group C. Furthermore, the median normalized protein catabolic rate was 0.86–1.05 g/kg/day, and there was no difference in the initial or final rates. The mean energy and protein daily intakes were 30–32 kcal/ideal body weight (IBW) kg/day and 1.1 g/IBW kg/day, respectively.
Conclusions
In patients undergoing hemodialysis, even if the muscle mass values are maintained, the possibility of a substantial decrease in muscle mass cannot be ruled out when ECW/TBW increases. Control of inflammation and nutritional intake may help minimize muscle mass loss caused by continued hemodialysis in patients.
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Preoperative volume assessment using bioelectrical impedance analysis for minimizing blood loss during hepatic resection. HPB (Oxford) 2022; 24:568-574. [PMID: 34702628 DOI: 10.1016/j.hpb.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Maintaining low central venous pressure (CVP) is an effective strategy to reduce blood loss during hepatic resection. As an alternative to measuring CVP, which requires the placement of a central venous catheter, bioelectrical impedance analysis (BIA) is a noninvasive method recently used for monitoring volume status in critically ill patients. METHODS We investigated 192 patients who underwent hepatic resection from January 2017 to December 2020. The ratio of extracellular water:total body water (ECW/TBW), as an index of volume status, was measured using InBody S10 (Biospace, Seoul, Korea). The correlation between the ECW/TBW and CVP was determined, and their influences on operative outcomes were analyzed. RESULTS ECW/TBW and CVP showed a significant correlation; an ECW/TBW <0.378 correlated with a CVP <5 mmHg (R2 = 0.839, P<0.001). Estimated blood loss (EBL) was significantly increased in patients with an ECW/TBW ≥0.378 compared to those with a ratio <0.378 (508 ± 321 vs. 324 ± 193, mL, P<0.001). Identified predictors for an EBL ≥500 mL were operative time (odds ratio [OR], 1.008; 95% confidence interval [CI], 1.001-1.015; P = 0.021) and an ECW/TBW <0.378 (OR, 0.263; 95% CI, 0.121-0.572; P = 0.001). CONCLUSIONS BIA can be utilized for preoperative volume assessment to minimize blood loss during hepatic resection.
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Choi G, Yoon HJ, Song YJ, Jeong HM, Gu JE, Han M, Kim SH, Yoon JW, Kim H. Consistency of the estimated target weights and ECW/TBW using BIA after hemodialysis in patients between standing and lying-down positions. BMC Nephrol 2022; 23:106. [PMID: 35300597 PMCID: PMC8928688 DOI: 10.1186/s12882-022-02737-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 03/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background As hemodialysis is administered with the patient lying down, the distribution of body fluid is stable in the lying position, which is why this position is recommended for bioimpedance analysis (BIA). Although the InBody S10 is widely used for hemodialysis patients in the lying position, clinicians must make the measurements in person. In contrast, patients can use the InBody 770 to obtain measurements by themselves in the standing position, which may be more convenient. Therefore, this study compared the measurements of hemodialysis patients’ estimated target weight and ECW/TBW obtained lying down using the S10 to those obtained in the standing position using the 770. Methods This study was conducted among maintenance hemodialysis patients at Chuncheon Sacred Heart Hospital in October 2020. Measurements from 56 patients before and after hemodialysis were obtained using the 2 machines. Each (S10 or 770) estimated target weight, both pre- and post-hemodialysis, was considered ideal when the ECW/TBW ratio was 0.380. R2 was calculated and the Bland-Altman test was performed. Results The patients’ median age was 64 years old, and 51% were men. The actual ultrafiltration was 2 kg, and the mean TBW change measured using the InBody devices was 1.5 L (R2 = 0.718) for the S10 and 1.7 L (R2 = 0.616) for the 770. The estimated target weight at pre- and post-hemodialysis showed a remarkably high correlation with the patients’ actual pre- and post-hemodialysis weight (R2 > 0.095). The correlation between these measurements (lying vs. standing) before and after hemodialysis was also very close (R2 = 1.0000). In addition, ECW/TBW had a good correlation (R2 ≥ 0.970) The Bland-Altman test of dry weight and ECW/TBW yielded similar results. Conclusions This study showed that patients’ estimated target weights in the lying position using the InBody S10 device and in the standing position using the InBody 770 device were consistent in both pre- and post-hemodialysis states. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02737-3.
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Affiliation(s)
- Gwangho Choi
- Department of Internal Medicine, Hallym University Medical Center, Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Ho Joong Yoon
- Department of Internal Medicine, Hallym University Medical Center, Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Young Jin Song
- Department of Internal Medicine, Hallym University Medical Center, Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Hae Min Jeong
- Department of Internal Medicine, Hallym University Medical Center, Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Jae Eon Gu
- Department of Internal Medicine, Hallym University Medical Center, Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Miyeun Han
- Department of Internal Medicine, Hallym University Medical Center, Hangang Sacred Heart Hospital, Seoul, 07247, Republic of Korea
| | - Seok Hyung Kim
- Department of Internal Medicine, Hallym University Medical Center, Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, Hallym University Medical Center, Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Hyunsuk Kim
- Department of Internal Medicine, Hallym University Medical Center, Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24253, Republic of Korea.
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Blue MNM, Hirsch KR, Brewer GJ, Cabre HE, Gould LM, Tinsley GM, Ng BK, Ryan ED, Padua D, Smith-Ryan AE. The validation of contemporary body composition methods in various races and ethnicities. Br J Nutr 2022; 128:1-11. [PMID: 35109945 DOI: 10.1017/s0007114522000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Few investigations have evaluated the validity of current body composition technology among racially and ethnically diverse populations. This study assessed the validity of common body composition methods in a multi-ethnic sample stratified by race and ethnicity. One hundred and ten individuals (55 % female, age: 26·5 (sd 6·9) years) identifying as Asian, African American/Black, Caucasian/White, Hispanic, Multi-racial and Native American were enrolled. Seven body composition models (dual-energy X-ray absorptiometry (DXA), air displacement plethysmography (ADP), two bioelectrical impedance devices (BIS, IB) and three multi-compartment models) were evaluated against a four-compartment criterion model by assessing total error (TE) and standard error of the estimate. For the total sample, measures of % fat and fat-free mass (FFM) from multi-compartment models were all excellent to ideal (% fat: TE = 0·94-2·37 %; FFM: TE = 0·72-1·78 kg) compared with the criterion. % fat measures were very good to excellent for DXA, ADP and IB (TE = 2·52-2·89 %) and fairly good for BIS (TE = 4·12 %). For FFM, single device estimates were good (BIS; TE = 3·12 kg) to ideal (DXA, ADP, IB; TE = 1·21-2·15 kg). Results did not vary meaningfully between each race and ethnicity, except BIS was not valid for African American/Black, Caucasian/White and Multi-racial participants for % fat (TE = 4·3-4·9 %). The multi-compartment models evaluated can be utilised in a multi-ethnic sample and in each individual race and ethnicity to obtain highly valid results for % fat and FFM. Estimates from DXA, ADP and IB were also valid. The BIS may demonstrate greater TE for all racial and ethnic cohorts and results should be interpreted cautiously.
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Affiliation(s)
- Malia N M Blue
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Katie R Hirsch
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, Center for Translational Research in Aging & Longevity, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Hannah E Cabre
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Lacey M Gould
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Grant M Tinsley
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Bennett K Ng
- Emerging Growth and Incubation Group, Intel Corporation, Santa Clara, CA, USA
| | - Eric D Ryan
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Darin Padua
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Abbie E Smith-Ryan
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
- Department of Nutrition, The University of North Carolina, Chapel Hill, NC, USA
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10
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Yajima T, Yajima K, Takahashi H. Annual change in the extracellular fluid/intracellular fluid ratio and mortality in patients undergoing maintenance hemodialysis. Sci Rep 2022; 12:242. [PMID: 34997150 PMCID: PMC8741928 DOI: 10.1038/s41598-021-04366-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022] Open
Abstract
We aimed to investigate whether annual change in the extracellular fluid to intracellular fluid (ΔECF/ICF) ratio can accurately predict mortality in hemodialysis patients. Totally, 247 hemodialysis patients were divided into two groups according to the median baseline ECF/ICF ratio of 0.563 and ΔECF/ICF ≥ 0% or < 0% during the first year, respectively. Thereafter, they were divided into four groups according to each cutoff point and were followed up for mortality assessment. The ECF/ICF ratio increased from 0.566 ± 0.177 to 0.595 ± 0.202 in the first year (P = 0.0016). During the 3.4-year median follow-up, 93 patients died (42 cardiovascular-specific causes). The baseline ECF/ICF ≥ 0.563 and ΔECF/ICF ≥ 0% were independently associated with all-cause mortality (adjusted hazard ratio [aHR] 4.55, 95% confidence interval [CI] 2.60-7.98 and aHR 8.11, 95% CI 3.47-18.96, respectively). The aHR for ECF/ICF ≥ 0.563 and ΔECF/ICF ≥ 0% vs. ECF/ICF < 0.563 and ΔECF/ICF < 0% was 73.49 (95% CI 9.45-571.69). For model discrimination, adding the ΔECF/ICF (0.859) alone and both the baseline ECF/ICF and ΔECF/ICF (0.903) to the established risk model (0.746) significantly improved the C-index. Similar results were obtained for cardiovascular mortality. In conclusion, the ΔECF/ICF ratio could not only predict all-cause and cardiovascular mortality but also improve predictability of mortality in hemodialysis patients.
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Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu, 501-6062, Japan.
| | - Kumiko Yajima
- Department of Internal Medicine, Matsunami General Hospital, Gifu, 501-6062, Japan
| | - Hiroshi Takahashi
- Division of Medical Statistics, Fujita Health University School of Medicine, Aichi, 470-1192, Japan
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Wang Y, Gu Z. Effect of bioimpedance-defined overhydration parameters on mortality and cardiovascular events in patients undergoing dialysis: a systematic review and meta-analysis. J Int Med Res 2021; 49:3000605211031063. [PMID: 34496645 PMCID: PMC8438275 DOI: 10.1177/03000605211031063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/18/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the role of bioimpedance-defined overhydration (BI-OH) parameters in predicting the risk of mortality and cardiovascular (CV) events in patients undergoing dialysis. METHODS We searched multiple electronic databases for studies investigating BI-OH indicators in the prediction of mortality and CV events through 23 May 2020. We assessed the effect of BI-OH indexes using unadjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity analysis was used for each outcome. RESULTS We included 55 studies with 104,758 patients in the meta-analysis. Extracellular water/total body water (ECW/TBW) >0.4 (HR 5.912, 95% CI: 2.016-17.342), ECW/intracellular water (ICW) for every 0.01 increase (HR 1.041, 95% CI: 1.031-1.051), and OH/ECW >15% (HR 2.722, 95% CI: 2.005-3.439) increased the risk of mortality in patients receiving dialysis. ECW/TBW >0.4 (HR 2.679, 95% CI: 1.345-5.339) and ECW/ICW per increment of 10% (HR 1.032, 95% CI: 1.017-1.047) were associated with an increased risk of CV events in patients undergoing dialysis. A 1-degree increase in phase angle was a protective factor for both mortality (HR 0.676, 95% CI: 0.474-0.879) and CV events (HR 0.736, 95% CI: 0.589-0.920). CONCLUSIONS BI-OH parameters might be independent predictors for mortality and CV events in patients undergoing dialysis.
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Affiliation(s)
- Yajie Wang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zejuan Gu
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
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Akiyama Y, Matsuoka R, Masuda T, Iwamoto S, Sugie S, Muto T, Miyamoto Y, Ohdate T, Nakagawa S, Okada M, Imai T, Komada T, Suzuki M, Maeshima A, Akimoto T, Saito O, Nagata D. Comparative Impact of Isolated Ultrafiltration and Hemodialysis on Fluid Distribution: A Bioimpedance Study. Blood Purif 2021; 51:492-502. [PMID: 34515071 DOI: 10.1159/000518228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/29/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Isolated ultrafiltration (IUF) is an alternative treatment for diuretic-resistant patients with fluid retention. Although hemodialysis (HD) predominantly decreases extracellular water (ECW), the impact of IUF on fluid distribution compared with HD remains unclear. METHODS We compared the effect of HD (n = 22) and IUF (n = 10) sessions on the body fluid status using a bioimpedance analysis device (InBody S10). RESULTS The total ultrafiltration volume was similar between HD and IUF (HD 2.5 ± 0.3 vs. ICF 2.1 ± 0.3 L/session, p = 0.196). The reduction rate of ECW was significantly higher than that of intracellular water (ICW) after HD (ECW -7.9% ± 0.8% vs. ICW -3.0% ± 0.9%, p < 0.001) and IUF (ECW -5.8% ± 0.9% vs. ICW -3.6% ± 0.8%, p = 0.048). However, the change in the ratio of ECW to total body water in HD was significantly larger than that in IUF (HD -3.2% ± 0.3% vs. ICF -1.1% ± 0.4%, p < 0.001). The reduction rates in serum tonicity (effective osmolality) were higher after HD than after IUF (HD -1.8% ± 0.5% vs. IUF -0.6% ± 0.2%, p = 0.052). Among the components of effective osmolality, the reduction rates of serum K+ and glucose levels after HD were significantly higher than those after IUF (serum K+: HD -30.5% ± 1.6% vs. IUF -0.5% ± 3.8%, p < 0.001; serum glucose: HD -15.4% ± 5.0% vs. IUF 0.7% ± 4.8%, p = 0.026), while the serum Na+ level was slightly and similarly reduced (HD -0.8% ± 0.4% vs. IUF -0.8% ± 0.4%, p = 0.500). The reduction in the osmolal gap value (measured osmolality-calculated osmolarity) was significantly greater after HD sessions than after IUF sessions (HD -12.4 ± 1.4 vs. IUF 2.0 ± 1.0 mOsm/kg, p = 0.001). CONCLUSION The extracellular fluid reduction effect of HD is stronger than that of IUF. The different changes in effective osmolality and osmolal gap after HD and IUF sessions may be related to the different effects of HD and IUF on fluid distribution.
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Affiliation(s)
- Yuki Akiyama
- Department of Clinical Engineering, Jichi Medical University, Tochigi, Japan
| | - Ryo Matsuoka
- Department of Clinical Engineering, Jichi Medical University, Tochigi, Japan
| | - Takahiro Masuda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Sumiya Iwamoto
- Department of Clinical Engineering, Jichi Medical University, Tochigi, Japan
| | - Shun Sugie
- Department of Clinical Engineering, Jichi Medical University, Tochigi, Japan
| | - Takafumi Muto
- Department of Clinical Engineering, Jichi Medical University, Tochigi, Japan
| | - Yuka Miyamoto
- Department of Clinical Engineering, Jichi Medical University, Tochigi, Japan
| | - Takayuki Ohdate
- Department of Clinical Engineering, Jichi Medical University, Tochigi, Japan
| | - Saki Nakagawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Mari Okada
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Toshimi Imai
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Takanori Komada
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Michiko Suzuki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Akito Maeshima
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Osamu Saito
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
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Kang SH, Kim AY, Do JY. Comparison of lean mass indices as predictors of mortality in incident peritoneal dialysis patients. PLoS One 2021; 16:e0254942. [PMID: 34293044 PMCID: PMC8297877 DOI: 10.1371/journal.pone.0254942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Few studies have considered optimal adjusted lean mass indices for prediction of clinical outcomes in peritoneal dialysis (PD) patients. We aimed to evaluate clinical variables using various adjusted indices in PD patients. Methods Total 528 incident PD patients were included. Lean mass was measured using dual energy X-ray absorptiometry. Appendicular lean mass (ALM) was calculated using the sum for both upper and lower extremities. Each ALM index was calculated using ALM per body weight (ALM/BW), height squared (ALM/Ht2), or body mass index (ALM/BMI). Limb/trunk lean mass (LTLM) ratio was defined as the sum for both upper and lower extremities divided by trunk lean mass. Results A total of 528 patients were analyzed men: 286, women: 242. In area under the receiver operating characteristic curve analyses, LTLM alone was associated with 1 year mortality. In the LTLM ratio, the cut-off value for 1-year mortality was ≤ 0.829 in men and ≤ 0.717 in women, respectively. In both sexes, LTLM ratio alone showed statistical significance in all-cause mortality in both univariate and multivariate Cox-regression analyses. Compared with other indices, the LTLM ratio was independent of edema and fat in both sexes. Edema- and C-reactive protein-adjusted correlation analysis showed that LTLM ratio alone was associated with serum albumin in men. Although statistical significance was not obtained for women, the correlation coefficient was highest for the LTLM ratio compared with other indices. Conclusion Among various indices using lean mass, LTLM ratio was independent of volume status and fat mass and was associated with mortality in incident PD patients.
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Affiliation(s)
- Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - A. Young Kim
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
- * E-mail:
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Extracellular Water to Total Body Water Ratio in Septic Shock Patients Receiving Protocol-Driven Resuscitation Bundle Therapy. J Clin Med 2021; 10:jcm10132917. [PMID: 34209962 PMCID: PMC8269068 DOI: 10.3390/jcm10132917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Bio-electrical impedance analysis (BIA) is a rapid, simple, and noninvasive tool for evaluating the metabolic status and for assessing volume status in critically ill patients. Little is known, however, the prognostic value of body composition analysis in septic shock patients. This study assessed the association between parameters by body composition analysis and mortality in patients with septic shock in the emergency department (ED). (2) Data were prospectively collected on adult patients with septic shock who underwent protocol-driven resuscitation bundle therapy between December 2019 and January 2021. The primary outcome was 30-day mortality. (3) The study included 261 patients, the average ratio of extracellular water (ECW) to total body water (TBW) was significantly higher in non-survivors than in survivors (0.414 vs. 0.401, p < 0.001). Multivariate analysis showed that ECW/TBW ≥ 0.41 (odds ratio (OR), 4.62; 95% confidence interval (CI), 2.31–9.26, p < 0.001), altered mental status (OR, 2.88; 95% CI, 1.28–6.46, p = 0.010), and lactate level (OR, 1.24; 95% CI, 1.12–1.37, p < 0.001) were significantly associated with 30-day mortality in patients with septic shock. (4) ECW/TBW ≥ 0.41 may be associated with 30-day mortality in patients with septic shock receiving protocol-driven resuscitation bundle therapy in the ED.
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Pérez-Morales R, Donate-Correa J, Martín-Núñez E, Pérez-Delgado N, Ferri C, López-Montes A, Jiménez-Sosa A, Navarro-González JF. Extracellular water/total body water ratio as predictor of mortality in hemodialysis patients. Ren Fail 2021; 43:821-829. [PMID: 33966595 PMCID: PMC8118427 DOI: 10.1080/0886022x.2021.1922442] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Overhydration is a predictor of mortality in hemodialysis (HD) patients. Bioimpedance spectroscopy (BIS) is used to determine the body composition. Extracellular Water/Total Body Water (ECW/TBW) ratio has been proposed to predict mortality. Methods Multicenter, prospective, observational, proof-of-concept study to estimate the impact of ECW/TBW in global and cardiovascular mortality and the relationship with cardiovascular biomarkers. The study included 60 patients (mean age, 71.8 ± 11.4 years; mean time on HD, 52.3 ± 30.8 months) with a median follow-up of 30.5 months (IQ range, 17.2–34 months). Results Post-dialysis ECW/TBW was directly associated with NT-proBNP and cTnT. During the study 28 patients died, most of them (43%) due to cardiovascular events. Compared to the survivors, these subjects had a higher post-dialysis ECW/TBW ratio (p = 0.006), while for cardiovascular mortality the only significant difference was a higher pre-dialysis ECW/TBW. The ability of post-dialysis ECW/TBW ratio to predict all-cause mortality had an area under the ROC curve (AUC) of 0.71 (CI 95%, 0.57–0.81; p = 0.002), with a cutoff point of 0.5023. For cardiovascular mortality the AUC was 0.66 (CI 95%, 0.52–0.77; p = 0.045), with a cutoff point of 0.4713. Conclusions The post-dialysis ECW/TBW ratio measured by BIS can be a predictor of all-cause and cardiovascular mortality.
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Affiliation(s)
- Rosa Pérez-Morales
- Nephrology Department, Hospital Universitario Nuestra Señora de Candelaria (HUNSC), Santa Cruz de Tenerife, Spain
| | | | | | | | - Carla Ferri
- Research Unit, HUNSC, Santa Cruz de Tenerife, Spain
| | - Aurora López-Montes
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Juan Francisco Navarro-González
- Nephrology Department, Hospital Universitario Nuestra Señora de Candelaria (HUNSC), Santa Cruz de Tenerife, Spain.,Research Unit, HUNSC, Santa Cruz de Tenerife, Spain
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Kishino K, Enomoto H, Shimono Y, Moriwaki EI, Nishikawa H, Nishimura T, Iwata Y, Iijima H, Nishiguchi S. Association of an Overhydrated State With the Liver Fibrosis and Prognosis of Cirrhotic Patients. In Vivo 2021; 34:1347-1353. [PMID: 32354929 DOI: 10.21873/invivo.11912] [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] [Received: 01/21/2020] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM A bioimpedance analysis (BIA) can indicate an overhydrated state as the extracellular water/total body water (ECW/TBW) value. This study aimed to assess the clinical significance of this value in patients with chronic liver diseases (CLDs). PATIENTS AND METHODS A total of 552 CLD patients who received a liver biopsy and underwent anthropometric assessment and BIA-based body composition analysis were enrolled. The association of the ECW/TBW value with the liver fibrosis and nutritional status was assessed. The relationship between the ECW/TBW value and the prognosis of cirrhotic patients (N=209) was also evaluated. RESULTS The ECW/TBW value increased as liver fibrosis progressed and was also related to decreased muscle mass/sarcopenia. The presence of overhydration was associated with a poor prognosis of cirrhotic patients. CONCLUSION An increased ECW/TBW value was associated with progressive liver fibrosis and malnutrition and related to the prognosis of cirrhotic patients.
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Affiliation(s)
- Kyohei Kishino
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Hirayuki Enomoto
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshihiro Shimono
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Ei-Ichiro Moriwaki
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.,Department of Gastroenterology, Kano General Hospital, Osaka, Japan
| | - Hiroki Nishikawa
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Takashi Nishimura
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshinori Iwata
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Hiroko Iijima
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Shuhei Nishiguchi
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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Schneditz D, Sauseng N, Pütün E, Rosenkranz AR, Ribitsch W. Supine equilibration of extracellular fluid in peritoneal dialysis varies with intra-abdominal pressure. Perit Dial Int 2020; 40:477-486. [PMID: 32063186 DOI: 10.1177/0896860819895176] [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] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Increased intra-abdominal pressure (PIA) leads to venous congestion in splanchnic and adjoining circulations. The aim is to examine whether PIA in peritoneal dialysis (PD) affects the mobilization of extracellular fluid from the lower body in supine body position. METHODS Patients were studied during a regular peritoneal equilibration test (PET) in supine body position using multifrequency bioimpedance analysis to determine extracellular resistance and absolute volume overload (AVO) in wrist-to-ankle (W2A) as well as in ankle-to-ankle (A2A) configurations. Measurements were taken at baseline (T0) after draining the peritoneal cavity, at T1 shortly after filling with 2 L of standard dialysate, and at T2 before taking the 2 h PET samples. PIA was measured from the column height in the PD catheter. Extracellular resistance in the lower extremities (RL) was taken as half of the A2A resistance. RESULTS Eighteen patients (56 ± 15 years, 76 ± 21 kg, body mass index (BMI) 26.4 ± 7 kg/m2, 13 men) were studied. After having assumed a supine body position for the duration of 17, 77, and 155 min, AVO continuously decreased from 1.6 ± 1.3 (T0) to 1.2 ± 1.5 (T1) and 1.0 ± 1.4 L (T2). RL significantly increased from 238 ± 57 (T0) to 254 ± 62 (T1) and 264 ± 67 Ohm (T2). This increase was negatively correlated to BMI and PIA measured at any time point, but not to net ultrafiltration volume. CONCLUSIONS Orthostatic fluid shifts from the lower limbs may take up to 2 h in supine PD patients, especially with high BMI and PIA because of venous congestion in splanchnic and adjoining circulations.
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Affiliation(s)
- Daniel Schneditz
- Division of Physiology, Otto Loewi Research Center, 31475Medical University of Graz, Graz, Austria
| | - Notburga Sauseng
- Division of Physiology, Otto Loewi Research Center, 31475Medical University of Graz, Graz, Austria
| | - Ezgi Pütün
- Division of Nephrology, Department of Internal Medicine, 31475Medical University of Graz, Graz, Austria
| | - Alexander R Rosenkranz
- Division of Nephrology, Department of Internal Medicine, 31475Medical University of Graz, Graz, Austria
| | - Werner Ribitsch
- Division of Nephrology, Department of Internal Medicine, 31475Medical University of Graz, Graz, Austria
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Ohara K, Masuda T, Morinari M, Okada M, Miki A, Nakagawa S, Murakami T, Oka K, Asakura M, Miyazawa Y, Maeshima A, Akimoto T, Saito O, Nagata D. The extracellular volume status predicts body fluid response to SGLT2 inhibitor dapagliflozin in diabetic kidney disease. Diabetol Metab Syndr 2020; 12:37. [PMID: 32377235 PMCID: PMC7195732 DOI: 10.1186/s13098-020-00545-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/22/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors are an antihyperglycemic drug with diuretic action. We recently reported that the SGLT2 inhibitor dapagliflozin ameliorates extracellular volume expansion with a mild increase in urine volume. However, the impact of the pretreatment extracellular volume status on the body fluid response to SGLT2 inhibitors remains unclear. METHODS Thirty-six diabetic kidney disease (DKD) patients were treated with dapagliflozin. The body fluid volume, including intracellular water (ICW), extracellular water (ECW) and total body water (TBW), were measured on baseline and day 7 using a bioimpedance analysis (BIA) device. The ECW/TBW and ECW were used as markers of the extracellular volume status. For a comparison, the extracellular volume status responses to loop diuretic furosemide (n = 16) and vasopressin V2 receptor antagonist tolvaptan (n = 13) were analyzed. RESULTS The body weight, brain natriuretic peptide and body fluid parameters measured by a BIA (ICW, ECW, TBW, and ECW/TBW) were significantly decreased for 1 week after dapagliflozin administration. The change in the ECW/TBW in the high-ECW/TBW group (over the median value of 0.413) was significantly higher than in the low-ECW/TBW group (- 2.1 ± 0.4 vs. - 0.5 ± 0.4%, p = 0.006). Only with dapagliflozin treatment (not furosemide or tolvaptan treatment) was the baseline ECW/TBW significantly correlated with the changes in the ECW/TBW (r = - 0.590, p < 0.001) and ECW (r = - 0.374, p = 0.025). CONCLUSIONS The pretreatment extracellular volume status predicts the body fluid response to the SGLT2 inhibitor dapagliflozin in DKD patients. The diminished extracellular fluid reduction effect of dapagliflozin in patients without severe extracellular fluid retention may contribute to maintaining a suitable body fluid status.
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Affiliation(s)
- Ken Ohara
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Takahiro Masuda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Masato Morinari
- Department of Internal Medicine, Nasu Minami Hospital, Nasukarasuyama, Tochigi Japan
| | - Mari Okada
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Atsushi Miki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Saki Nakagawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Takuya Murakami
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Kentaro Oka
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Maki Asakura
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Yasuharu Miyazawa
- Department of Internal Medicine, Nasu Minami Hospital, Nasukarasuyama, Tochigi Japan
| | - Akito Maeshima
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Osamu Saito
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
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19
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The role of Bioelectrical Impedance Analysis In Assessment Of Fluid Volume Status In Chronic Hemodialysis Patients. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.684623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Terada M, Yoshimura A, Sawaki M, Hattori M, Naomi G, Kotani H, Adachi Y, Iwase M, Kataoka A, Sugino K, Mori M, Horisawa N, Ozaki Y, Iwata H. Patient-reported outcomes and objective assessments with arm measurement and bioimpedance analysis for lymphedema among breast cancer survivors. Breast Cancer Res Treat 2019; 179:91-100. [DOI: 10.1007/s10549-019-05443-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
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21
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Ohara K, Masuda T, Murakami T, Imai T, Yoshizawa H, Nakagawa S, Okada M, Miki A, Myoga A, Sugase T, Sekiguchi C, Miyazawa Y, Maeshima A, Akimoto T, Saito O, Muto S, Nagata D. Effects of the sodium-glucose cotransporter 2 inhibitor dapagliflozin on fluid distribution: A comparison study with furosemide and tolvaptan. Nephrology (Carlton) 2019; 24:904-911. [PMID: 30578654 DOI: 10.1111/nep.13552] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 01/08/2023]
Abstract
AIM Sodium-glucose cotransporter 2 (SGLT2) inhibitors are an antihyperglycemic drug with diuretic properties. We recently reported that an SGLT2 inhibitor ameliorated extracellular fluid expansion with a transient increase in urinary Na+ excretion. However, the effects of SGLT2 inhibitors on fluid distribution in comparison to conventional diuretics remain unclear. METHODS Forty chronic kidney disease patients with fluid retention (average estimated glomerular filtration rate 29.2 ± 3.2 mL/min per 1.73 m2 ) were divided into the SGLT2 inhibitor dapagliflozin (DAPA), loop diuretic furosemide (FR) and vasopressin V2 receptor antagonist tolvaptan (TLV). The body fluid volume was measured on days 0 and 7 using a bioimpedance analysis device. RESULTS In all three groups, body weight was significantly and similarly decreased, and urine volume numerically increased for 7 days. Bioimpedance analysis showed that the changes in intracellular water were similar, but that there were significant changes in the extracellular water (ECW) (DAPA -8.4 ± 1.7, FR -12.5 ± 1.3, TLV -7.4 ± 1.5%, P = 0.048). As a result, the change in the ratio of ECW to total body water in the DAPA group was significantly smaller than that in the FR group, but numerically larger than that in the TLV group (DAPA -1.5 ± 0.5, FR -3.6 ± 0.5, TLV -0.5 ± 0.4%, P < 0.001). CONCLUSION Sodium-glucose cotransporter 2 inhibitor DAPA predominantly decreased the ECW with a mild increase in urine volume, but the change in the ECW/total body water was smaller than that in patients treated with FR, and larger than that in patients treated with TLV, suggesting that the effects of SGLT2 inhibitors on fluid distribution may differ from those of conventional diuretics.
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Affiliation(s)
- Ken Ohara
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Takahiro Masuda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Takuya Murakami
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Toshimi Imai
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Hiromichi Yoshizawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Saki Nakagawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Mari Okada
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Atsushi Miki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Akihiro Myoga
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Taro Sugase
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | | | - Yasuharu Miyazawa
- Department of Internal Medicine, Nasu Minami Hospital, Tochigi, Japan
| | - Akito Maeshima
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Osamu Saito
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Shigeaki Muto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
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da Silva AT, Hauschild DB, de Almeida Oliveira LD, de Fragas Hinnig P, Franco Moreno YM, Wazlawik E. Association of hyperhydration evaluated by bioelectrical impedance analysis and mortality in patients with different medical conditions: Systematic review and meta-analyses. Clin Nutr ESPEN 2018; 28:12-20. [DOI: 10.1016/j.clnesp.2018.08.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 08/31/2018] [Indexed: 01/09/2023]
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