Fluid volume monitoring with electrical impedance technique during hemodialysis

Longitudinal changes and correlations of bioimpedance and anthropometric measurements in pregnancy: Simple possible bed-side tools to assess pregnancy evolution

PURPOSE

The aim of this study was to assess longitudinal changes of bioimpedance analysis compared with anthropometric measurements in low-risk pregnant woman recruited in the first trimester and to observe possible differences in these indices in women who developed high-risk pregnancies.

MATERIALS AND METHODS

Bioimpedance indices for the three trimesters of pregnancies were calculated separately for uneventful pregnancies delivered of newborns > the 10th centile. These findings were compared with anthropometric measurements. Data of women who developed hypertensive disorders of pregnancy (HDP) or delivered SGA newborns were calculated and compared.

RESULTS

Significantly longitudinal increases were observed in these pregnancies for total body water (TBW), free fat mass, fat mass, and extra-cellular water. These increases were paralleled body mass index (BMI), skinfolds, and waist measurements. The correlations between these two sets of findings were poor. Women who developed HDP with AGA fetuses showed significantly different bioimpedance from normal cases. TBW indices were highly significantly different since the first trimester. In pregnancies delivered of SGA newborns, these indices were opposite of the values observed in patients with HDP-AGA, TBW in these patients was significantly reduced compared with normal pregnancies.

CONCLUSIONS

The bioelectrical impedance is a fast, simple, noninvasive way to assess the TBW content in pregnancy. Our findings are in agreement with the hypothesis that bioimpedance might help to identify early in gestation patients at risk of developing different clinical phenotypes of hypertensive disease of pregnancy and SGA fetuses.

A bridge from bioimpedance spectroscopy to 50 kHz bioimpedance analysis: application to total body water measurements

This paper presents a method for extrapolating the total body water (TBW) resistance R(t50) from the resistance measured at 50 kHz (R(50)). A DXA examination and impedance measurements were carried out in a 1st group of 57 healthy volunteers with a Xitron 4200 multifrequency impedancemeter, in order to determine their values of R(t50) by comparison with resistances extrapolated at an infinite frequency by the Xitron (R(infinity)). TBW volumes were calculated using our modified BIS method (Jaffrin et al 2006 Med. Biol. Eng. Comput. 44 873-82) from R(infinity), R(t50) and from the fat-free mass measured by DXA, assuming a hydration rate of 73.2%. The same protocol and calculations were also carried out on a 2nd group of 21 subjects for independent validation. Data of the 1st group showed that values of R(t50), not significantly different from those of R(infinity), could be obtained by dividing R(50) by 1.231 in men and by 1.224 in women. Applying this method to the 2nd group yielded also values of R(t50) not significantly different from R(infinity). TBW volumes V(t50) obtained from R(t50) were not significantly different from those of our modified BIS method V(tn), or from TBW volumes obtained from DXA in both groups. A comparison with three BIA methods of TBW determination showed that our new method gave results in better agreement with TBW from DXA and from our modified BIS method.

Total body water measurement by a modification of the bioimpedance spectroscopy method

We propose a method for calculating directly total body water (TBW) volumes (V (t)) from whole body resistance extrapolated at infinite frequency (R (infinity)) using a XITRON 4200 impedance meter. Mean TBW resistivities for men and women were determined from measurements of R (infinity) and fat-free mass (FFM(d)) measured by DXA in 58 healthy subjects assuming an average hydration coefficient of 73.2%. Mean differences between V (t) measured by our new method and those deduced from DXA data were +0.11 +/- 1.61 L for women and +0.13 +/- 2.16 L for men. For validation, this method was tested with the same resistivities against a 2nd group of 16 volunteers and the mean difference between V (t) from impedance and DXA was -0.80 +/- 1.43 L. Since the resistance at 50 kHz (R (50)) was found to be equal, in average, to 1.230 R (infinity) for men and 1.223 R (infinity) for women, this method can also be applied at 50 kHz with a similar accuracy by estimating R (infinity) from R (50). When our new method was applied to the monitoring of water loss during 28 dialysis runs performed on 13 patients, it predicted a mean water loss equal to 94% of ultrafiltered volume.

Bioelectrical impedance analysis during pregnancy and neonatal birth weight

OBJECTIVE

To generate reference ranges for bioelectrical impedance indices throughout pregnancy and to investigate whether a relationship exists between these indices and the neonatal birth weight.

STUDY DESIGN

Pregnant women with a singleton gestation, gestational age lower than 12 weeks, and absence of medical diseases before pregnancy were enrolled. Patients with pregnancy complications, such as hypertensive disorders, diabetes, and antiphospholipides syndrome were excluded. Antrophometric maternal parameters and bioelectrical impedance measurements were performed during the first, second, third trimester of pregnancy, at delivery and 60 days after delivery. Height(2)/resistance (cm(2)/Omega) and height(2)/reactance (cm(2)/Omega) were utilized to estimate the total and extracellular body water amounts, respectively. Spearman rank correlations and cox proportional hazard modelling were used for statistical purposes.

RESULTS

169 patients completed all measurements. Total and extracellular water amounts significantly increase as pregnancy advances and return to the pre-pregnancy values within 60 days after delivery. After adjustment for gestational age at delivery, fetal sex, and smoking habits, height(2)/resistance at 25 weeks (hazard=1.04, 95% confidence interval (CI) 1.02-1.06, P<0.005), height(2)/resistance at 30 weeks (hazard=1.03, 95% CI 1.01-1.05, P<0.005), height(2)/reactance at 20 weeks (hazard=1.03,95% CI 1.01-1.05, P<0.005), and height(2)/reactance at 25 weeks (hazard=1.03, 95% CI 1.01-1.04, P<0.01) were found to be independent predictors of birth weight.

CONCLUSION

We have provided reference ranges for bioimpedance analysis during pregnancy, an easy, fast and non invasive method to estimate the body water composition during pregnancy. Bioelectrical impedance indices during the second trimester of pregnancy are independently related to the birth weight.

The importance of bioimpedance (BIA) analysis and Cardio Tens (24-h ABPM and ECG) monitoring in the dialysis programme

The authors performed bioimpedance analysis and Cardio Tens (24-h ABPM and ECG) monitoring in 66 patients (28 males, 38 females) treated in the chronic haemodialysis programme. They investigated the correlations between the body weights before, during and after dialysis, the changes of the water compartments and fat body weight, and the recorded values of blood pressure and ECG alterations. On the basis of the measurements by this non-invasive method it is concluded that, as a result of dialysis and ultrafiltration, the total body weight and total body water are decreasing in a greater extent in men than in women. By gradually decreasing the body weight, the optimal dry weight could be attained, which resulted in the reduction of blood pressure or even normotension. In the course of dialysis the values of bioimpedance and bioreactance increase. The intradialytic hypotensive indispositions were accompanied by a significant reduction of bioreactance (n = 16). The BMI, total body weight and total body water hyperlipidaemic, hypalbuminic patients with treatment-resistant hypertension are considerably larger than those of the patients with normal blood pressure (p<0.01). During Cardio Tens monitoring 53% of the patients proved to be dippers, 47% of whom had ST depression, while in 73% of the non-dippers ischaemic alterations were encountered together with high hyperbaric impact values. The total body weights and total water compartments of patients returning to dialysis with an excess body weight of more than 3.5 kg were significantly larger than of patients who were cooperative and had no oedemas. In the last hour of dialysis and during the following few hours, arrhythmias and ST depressions of the cardiovascularly instable patients appeared more frequently. The total water compartments of these patients are significantly larger than normotensive, normolipaemic patients with appropriate serum albumin concentrations. The importance of the BIA and Cardio Tens monitoring in determining the optimal dry body weight and improving the cardiovascular condition of the patients is emphasized.

Body fluid distribution in man in space and effect of lower body negative pressure treatment

The lack of hydrostatic forces in space eventually produces a fluid deficit within the circulatory system. This deficit may alter the circulatory regulation patterns. The aim of the present study was to determine how much of this fluid deficit is attributable to interstitial fluid losses and to determine the effects of lower body negative pressure (LBNP) treatment on fluid distribution. The body fluid distribution of one subject was assessed before, during, and after weightlessness using two electrical impedance methods: (a) standard quadripole impedance for the segments of upper torso, lower torso, thigh, and calf and (b) an electrical impedance tomography technique (applied potential tomography) for a thigh cross-section. To assess the content of interstitial free fluid a thigh cuff overlying the electrodes for applied potential tomography was inflated to suprasystolic values to ascertain how much fluid can be squeezed out of blood vessels and tissue of skin and muscle. After the first thigh cuff maneuver (CUFF I) the subject performed a cardiovascular stress test with LBNP to mimic the gravity-induced blood shift to the lower part of the body. Then the compression maneuver was repeated (CUFF II). (a) This experimental sequence demonstrated a reduction in interstitial fluid in weightlessness of roughly 40% at the thigh. (b) The CUFF I and LBNP experiment demonstrated a reduced ability to cope with blood pooling in microgravity. (c) The CUFF II experiment suggests that LBNP in microgravity can refill the interstitial spaces and counteract the associated cardiovascular deterioration. The impedance measurements provided estimates of the contribution of different body sections to the observed body weight loss of more than 6 kg. The chest contributed nothing of significance, the lower torso more than 0.5 l, and both calves roughly 1.5 l. The thigh segments of both legs contributed between 1.5 l and 2.0 l with an interstitial free fluid reduction in muscle and skin by 40%.

Implications of the dielectrical behaviour of human blood for continuous online measurement of haematocrit

A study was designed to explore the possibility of detecting the haematocrit of blood by means of admittance measurements. The admittance and phase angle of blood kept in a measuring cell were determined at various frequencies between 60 kHz and 24 MHz. A reliable and accurate estimation of haematocrit was obtained in two ways. First, low-frequency admittance, high-frequency admittance and a factor x, which was the conductive percentage of cell content, were used. Secondly, the maximum phase angle was used. Both methods can be applied to obtain continuous on-line information about haematocrit for blood volume control during haemodialysis.

Whole body impedance measurements reflect total body water changes. A study in hemodialysis patients

Fluid volume changes during hemodialysis was monitored by continuous whole body impedance measurements. The fluid changes recorded using this method was compared to fluid volume changes measured in plasma water (PV) using 125I-albumin, and extracellular volume (ECV) using 51Cr-EDTA before and after treatment, and total body water (TBW) changes reflected by continuous bed scale monitoring. Changes in impedance correlated to TBW changes, r = 0.80, p less than 0.001, while correlations to changes in ECV and PV were: r = 0.57 and r = 0.55, respectively, p less than 0.05. Alterations in body fluid volumes recorded with whole body impedance is best correlated to total body water changes. The use of continuous whole body impedance monitoring has been shown to offer a simple non-invasive method for recording total body water changes during hemodialysis.

Fluid volume changes during hemodialysis monitored with the impedance technique

A fluid monitor based on the tetrapolar impedance technique was employed for continuous measurements of fluid volume change during hemodialysis treatment and compared to concomitant ultrafiltration and bed scale readings. Oral fluid intake before and during the dialysis immediately could be recorded with the bed scale as a weight change. In the readings of the fluid monitor, however, the response to fluid intake could be recorded only gradually, as the fluid was absorbed from the gastrointestinal tract. Taking this into account, together with a previously described artifact due to shifts in body position, an excellent agreement was obtained between impedance and bed scale fluid volume monitoring. It is concluded that impedance measurements give a better estimation of the amount of metabolically active fluid than does body weight monitoring.

Evaluation of impedance technique for fluid-volume monitoring during hemodialysis

Fluid-volume changes during hemodialysis were studied in 30 patients at four separate treatments in each patient. Readings of fluid-volume changes obtained by a fluid-balance monitor with non-invasive tetrapolar impedance technique were compared to changes in weight caused by the treatment. A correlation coefficient of r = 0.90 (p less than 0.001) was found. A survey of papers describing impedance measurements during hemodialysis or diuresis is also presented.