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Sánchez-Tocino ML, Mas-Fontao S, Gracia-Iguacel C, Pereira M, González-Ibarguren I, Ortiz A, Arenas MD, Parra EG. A Sarcopenia Index Derived from Malnutrition Parameters in Elderly Haemodialysis Patients. Nutrients 2023; 15:nu15051115. [PMID: 36904114 PMCID: PMC10005100 DOI: 10.3390/nu15051115] [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: 12/27/2022] [Revised: 02/12/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
(1) Background: Persons with chronic kidney disease may have sarcopenia characterized by the loss of muscle mass and loss of muscle strength. However, EWGSOP2 criteria to diagnose sarcopenia are technically challenging, especially in elderly persons on hemodialysis. Sarcopenia may be associated with malnutrition. We aimed at defining a sarcopenia index derived from malnutrition parameters for use in elderly haemodialysis patients. (2) Methods: A retrospective study of 60 patients aged 75 to 95 years treated with chronic hemodialysis was conducted. Anthropometric and analytical variables, EWGSOP2 sarcopenia criteria and other nutrition-related variables were collected. Binomial logistic regressions were used to define the combination of anthropometric and nutritional parameters that best predict moderate or severe sarcopenia according to EWGSOP2, and performance for moderate and severe sarcopenia was assessed by the area under the curve (AUC) of receiver operating characteristic (ROC) curves. (3) Results: The combination of loss of strength, loss of muscle mass and low physical performance correlated with malnutrition. We developed regression-equation-related nutrition criteria that predicted moderate sarcopenia (elderly hemodialysis sarcopenia index-moderate, EHSI-M) and severe sarcopenia (EHSI-S) diagnosed according to EWGSOP2 with an AUC of 0.80 and 0.866, respectively. (4) Conclusions: There is a close relationship between nutrition and sarcopenia. The EHSI may identify EWGSOP2-diagnosed sarcopenia from easily accessible anthropometric and nutritional parameters.
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Affiliation(s)
| | - S. Mas-Fontao
- Servicio de Nefrología e Hipertensión, Fundación Jiménez Díaz, 28040 Madrid, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28029 Madrid, Spain
| | - C. Gracia-Iguacel
- Servicio de Nefrología e Hipertensión, Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - M. Pereira
- Fundación Renal Íñigo Álvarez de Toledo, 28003 Madrid, Spain
| | - I. González-Ibarguren
- Servicio de Geriatría, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
| | - A. Ortiz
- Servicio de Nefrología e Hipertensión, Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - M. D. Arenas
- Fundación Renal Íñigo Álvarez de Toledo, 28003 Madrid, Spain
| | - E. González Parra
- Servicio de Nefrología e Hipertensión, Fundación Jiménez Díaz, 28040 Madrid, Spain
- Correspondence:
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2
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Sánchez-Tocino ML, Miranda-Serrano B, Gracia-Iguacel C, de-Alba-Peñaranda AM, Mas-Fontao S, López-González A, Villoria-González S, Pereira-García M, Ortíz A, González-Parra E. Sarcopenia assessed by 4-step EWGSOP2 in elderly hemodialysis patients: Feasibility and limitations. PLoS One 2022; 17:e0261459. [PMID: 35025892 PMCID: PMC8758069 DOI: 10.1371/journal.pone.0261459] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/02/2021] [Indexed: 01/06/2023] Open
Abstract
Background In 2019, EWGSOP2 proposed 4 steps to diagnose and assess sarcopenia. We aimed to quantify the prevalence of sarcopenia according to the EWGSOP2 diagnostic algorithm and to assess its applicability in elderly patients on hemodialysis. Methods Prospective study of 60 outpatients on chronic hemodialysis aged 75- to 95-years, sarcopenia was assessed according to the 4-step EWGSOP2: Find: Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls (SARC-F); Assess: grip strength by dynamometry (GSD) and sit to stand to sit 5 (STS5); Confirm: appendicular skeletal muscle mass (ASM) by bioimpedance; Severity: gait speed (GS), Timed-Up and Go (TUG), and Short Physical Performance Battery (SPPB). Results The sequential four steps resulted in a prevalence of confirmed or severe sarcopenia of 20%. Most (97%) patients fulfilled at least one criterion for probable sarcopenia. The sensitivity of SARC-F for confirmed sarcopenia was low (46%). Skipping the SARC-F step increased the prevalence of confirmed and severe sarcopenia to 40% and 37%, respectively. However, 78% of all patients had evidence of dynapenia consistent with severe sarcopenia. Muscle mass (ASM) was normal in 60% of patients, while only 25% had normal muscle strength values (GSD). Conclusions According to the 4-step EWGSOP2, the prevalence of confirmed or severe sarcopenia was low in elderly hemodialysis patients. The diagnosis of confirmed sarcopenia underestimated the prevalence of dynapenia consistent with severe sarcopenia. Future studies should address whether a 2-step EWGSOP2 assessment (Assess-Severity) is simpler to apply and may provide better prognostic information than 4-step EWGSOP2 in elderly persons on hemodialysis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alberto Ortíz
- Servicio de Nefrología e Hipertensión, Fundación Jiménez Díaz, IIS-FJD UAM, Madrid, Spain
| | - Emilio González-Parra
- Servicio de Nefrología e Hipertensión, Fundación Jiménez Díaz, IIS-FJD UAM, Madrid, Spain
- * E-mail:
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Ismail AH, Schlieper G, Walter M, Floege J, Leonhardt S. Knee-to-knee Bioimpedance Measurements to Monitor Changes in Extracellular Fluid in Haemodynamic-unstable Patients During Dialysis. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2019; 10:55-62. [PMID: 33584883 PMCID: PMC7531213 DOI: 10.2478/joeb-2019-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Indexed: 06/12/2023]
Abstract
The feasibility of bioimpedance spectroscopy (BIS) techniques for monitoring intradialytic changes in body fluids is advancing. The aim of this study was to compare the knee-to-knee (kkBIS) with the traditional whole-body (whBIS) with respect to continuous assessment of fluid volume status in hemodialysis patients. Twenty patients divided into two groups, hemodynamically stable and unstable, were recruited. Bioimpedance data from two different electrodes configurations (hand-to-foot and knee-to-knee) were collected and retrospectively analysed. A good correlation between the two methods with respect to changes in extracellular resistance (Re) and Re normalized for ultrafiltration volume (ΔRe/UFV) with p < 0.001 was observed. The relationship between relative change (%) in ΔRe and that in patient weight was most notable with kkBIS (4.82 ± 3.31 %/kg) in comparison to whBIS (3.69 ± 2.90 %/kg) in unstable patients. Furthermore, results based on kkBIS showed a reduced ability of the thigh compartments to keep up with the volume changes in the trunk for unstable patients. kkBIS provided a comparable sensitivity to whBIS even in patients at risk of intradialytic hypotension while avoiding the need for the complex implementation imposed by whBIS or other configurations.
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Affiliation(s)
- Abdul Hamid Ismail
- Chair for Medical Information Technology, Helmholtz Institute, RWTH Aachen University, Pauwelsstr. 20, Aachen, Germany
| | - Georg Schlieper
- Department of Nephrology and Immunology (Medical Clinic II), RWTH Aachen University Hospital, Pauwelsstr. 30, Aachen, Germany
| | - Marian Walter
- Chair for Medical Information Technology, Helmholtz Institute, RWTH Aachen University, Pauwelsstr. 20, Aachen, Germany
| | - Jürgen Floege
- Department of Nephrology and Immunology (Medical Clinic II), RWTH Aachen University Hospital, Pauwelsstr. 30, Aachen, Germany
| | - Steffen Leonhardt
- Chair for Medical Information Technology, Helmholtz Institute, RWTH Aachen University, Pauwelsstr. 20, Aachen, Germany
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Park JH, Jo YI, Lee JH. Clinical usefulness of bioimpedance analysis for assessing volume status in patients receiving maintenance dialysis. Korean J Intern Med 2018; 33:660-669. [PMID: 29961308 PMCID: PMC6030410 DOI: 10.3904/kjim.2018.197] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 02/08/2023] Open
Abstract
Chronic volume overload is associated with left ventricular hypertrophy and high cardiovascular mortality in patients undergoing dialysis. Therefore, estimating body fluid status is important in these patients. However, most dry-weight assessments are still performed clinically, while attempts have been made to measure the volume status and dry weight of patients undergoing dialysis using bioimpedance analysis (BIA). BIA uses the electrical properties of the human body to alternate current flow and measures resistance values to estimate body water content and composition. BIA is divided into single-frequency BIA, multi-frequency BIA, and bioimpedance spectroscopy (BIS) according to the number of frequencies used, and into whole-body and segmental BIA according to whether or not the whole body is divided into segments. Extracellular water (ECW), intracellular water, and total body water (TBW) contents can be measured with BIA. Dry weight can be estimated by measuring the volume overload of the patient through the ECW/TBW and ECW-to-body weight ratios. Other estimation methods include the normovolemia/hypervolemia slope method, a resistance-reactance (RXc) graph, overhydration measurements using a body composition monitor, and calf BIS. In this review, we will examine the principles of BIA, introduce various volume status measurement methods, and identify the optimal method for patients undergoing dialysis.
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Affiliation(s)
- Jung Hwan Park
- Division of Nephrology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
- Correspondence to Jung Hwan Park, M.D. Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: +82-2-2030-7528 Fax: +82-2-2030-7748 E-mail:
| | - Young-Il Jo
- Division of Nephrology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jong-Ho Lee
- Division of Nephrology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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Abbas SR, Thijssen S, Penne EL, Raimann JG, Liu L, Sipahioglu MH, Seibert E, Wang Y, Chen Y, Xiao Q, Levin NW, Kotanko P, Zhu F. Effect of Change in Fluid Status Evaluated by Bioimpedance Techniques on Body Composition in Hemodialysis Patients. J Ren Nutr 2017; 28:183-190. [PMID: 29158062 DOI: 10.1053/j.jrn.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/01/2017] [Accepted: 09/15/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This prospective study uses calf bioimpedance spectroscopy (cBIS) to guide the attainment of dry weight (DWcBIS) in chronic hemodialysis (HD) patients. The primary aim of this study was to evaluate whether body composition is altered when fluid status is reduced to DWcBIS. METHODS Target post-HD weight was gradually reduced from baseline (BL) until DWcBIS was achieved. DWcBIS was defined as the presence of both flattening of the curve of extracellular resistance and the attainment calf normalized resistivity in the normal range during the dialysis treatment. Extracellular volume (ECV), intracellular volume, and total body water (TBW) were measured using whole body BIS (Hydra 4200). Fluid overload, lean body mass, and fat mass were calculated according to a body composition model. RESULTS Seventy-three patients enrolled and 60 completed the study (55 ± 13 years, 49% male). Twenty-eight patients (25% diabetes) achieved DWcBIS, whereas 32 patients (47% diabetes) did not. Number of treatment measurements were 16 ± 10 and 12 ± 13 studies per patient in the DWcBIS and non-DWcBIS groups, respectively. Although significant decreases in body weight and ECV were observed, lean body mass and FM did not differ significantly in both groups from BL to the end of study. ECV, ECV/TBW, and fluid overload were higher in the non-DWcBIS than in the DWcBIS group both at BL and at the end of study. Ratios of intradialytic changes in calf normalized resistivity, ECV, and ECV/TBW to ultrafiltration volume were significantly lower in diabetic than in non-diabetic patients. CONCLUSIONS This study shows that decreasing fluid status by gradual reduction of post-HD weight in both DWcBIS and Non-DWcBIS groups did not affect body composition significantly over a period of about 4 weeks.
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Affiliation(s)
| | | | - Erik L Penne
- Research Group, Renal Research Institute, New York; Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Li Liu
- Research Group, Renal Research Institute, New York; Institute of Nephrology, Peking University First Hospital, Beijing, China
| | - Murat H Sipahioglu
- Research Group, Renal Research Institute, New York; Kayseri University Hospital, Kayseri, Turkey
| | - Eric Seibert
- Research Group, Renal Research Institute, New York; Internal Medicine II, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Yuqi Chen
- University of California, Santa Barbara
| | | | - Nathan W Levin
- Research Group, Renal Research Institute, New York; Icahn School of Medicine at Mount Sinai, New York
| | - Peter Kotanko
- Research Group, Renal Research Institute, New York; Icahn School of Medicine at Mount Sinai, New York
| | - Fansan Zhu
- Research Group, Renal Research Institute, New York.
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Saran R, Padilla RL, Gillespie BW, Heung M, Hummel SL, Derebail VK, Pitt B, Levin NW, Zhu F, Abbas SR, Liu L, Kotanko P, Klemmer P. A Randomized Crossover Trial of Dietary Sodium Restriction in Stage 3-4 CKD. Clin J Am Soc Nephrol 2017; 12:399-407. [PMID: 28209636 PMCID: PMC5338699 DOI: 10.2215/cjn.01120216] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 10/31/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients with chronic kidney disease (CKD) are often volume expanded and hypertensive. Few controlled studies have assessed the effects of a sodium-restricted diet (SRD) in CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a randomized crossover trial to evaluate the effect of SRD (target <2 g sodium per day) versus usual diet on hydration status (by bioelectrical impedance spectroscopy) and blood pressure (BP) between May of 2009 and May of 2013. A total of 58 adults with stage 3-4 CKD were enrolled from two academic sites: University of Michigan (n=37) and University of North Carolina at Chapel Hill (n=21); 60% were men, 43% were diabetic, 93% were hypertensive, and mean age was 61 years. Participants followed SRD or usual diet for 4 weeks, followed by a 2-week washout period and a 4-week crossover phase. During the SRD, dieticians provided counseling every 2 weeks, using motivational interviewing techniques. RESULTS Whole-body extracellular volume and calf intracellular volume decreased by 1.02 L (95% confidence interval [95% CI], -1.48 to -0.56; P<0.001) and -0.06 L (95% CI, -0.12 to -0.01; P=0.02), respectively, implying decreased fluid content on the SRD compared with usual diet. Significant reductions in urinary sodium (-57.3 mEq/24 h; 95% CI, -81.8 to -32.9), weight (-2.3 kg; 95% CI, -3.2 to -1.5), and 24-hour systolic BP (-10.8 mmHg; 95% CI, -17.0 to -4.6) were also observed (all P<0.01). Albumin-to-creatinine ratio did not change significantly and mean serum creatinine increased slightly (0.1 mg/dl; 95% CI, -0.01 to 0.2; P=0.06). No period or carryover effects were observed. Results were similar when analyzed from phase 1 only before crossover, although P values were modestly larger because of the loss of power. CONCLUSIONS In this randomized crossover trial, implementation of SRD in patients with CKD stage 3-4 resulted in clinically and statistically significant improvement in BP and hydration status. This simple dietary intervention merits a larger trial in CKD to evaluate effects on major clinical outcomes.
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Affiliation(s)
- Rajiv Saran
- Division of Nephrology, Department of Internal Medicine
| | - Robin L. Padilla
- Department of Biostatistics, Kidney Epidemiology and Cost Center
| | - Brenda W. Gillespie
- Department of Biostatistics, Consulting for Statistics, Computing and Analytics Research, and
| | - Michael Heung
- Division of Nephrology, Department of Internal Medicine
| | - Scott L. Hummel
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
- Division Cardiology, Department of Internal Medicine, Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Vimal Kumar Derebail
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bertram Pitt
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nathan W. Levin
- Renal Research Institute, Research Division, New York, New York; and
| | - Fansan Zhu
- Renal Research Institute, Research Division, New York, New York; and
| | - Samer R. Abbas
- Renal Research Institute, Research Division, New York, New York; and
| | - Li Liu
- Renal Research Institute, Research Division, New York, New York; and
| | - Peter Kotanko
- Renal Research Institute, Research Division, New York, New York; and
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Philip Klemmer
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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7
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Tonelli M, Lloyd A, Pannu N, Klarenbach S, Ravani P, Jindal K, MacRae J, Unsworth L, Manns B, Hemmelgarn B. Extracellular fluid management and hypertension in urban dwelling versus rural dwelling hemodialysis patients. J Nephrol 2016; 31:103-110. [PMID: 27553110 DOI: 10.1007/s40620-016-0337-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/12/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rural-dwelling hemodialysis patients have less frequent contact with nephrologists than urban-dwelling patients, and are known to have higher mortality. We hypothesized that rural-dwelling hemodialysis patients would have more evidence of poorly controlled extracellular fluid volume (ECVF) than otherwise similar urban-dwellers. METHODS We studied prevalent hemodialysis patients within a single renal program in Alberta, Canada and assessed ECFV using bioimpedance spectroscopy (BIS). Our primary outcome was impedance vector length (ohm/m) as assessed by BIS using the Xitron Hydra 4200 device, where shorter vector length indicated poorer ECFV control. Because poor ECFV control can lead to hypertension, we also assessed pre- and post-dialysis blood pressure. We measured outcomes at baseline. RESULTS We studied 228 hemodialysis patients, of whom 115 (50.4 %) and 113 (49.6 %) were urban- and rural-dwelling, respectively. There were no differences in volume control in urban versus rural participants; odds ratio (OR) for vector length in the lowest sex-specific quartile of vector length was 0.93 (95 % CI 0.54, 1.59) after adjusting for age, sex, diabetic status, years since dialysis initiation and phase angle. The odds of very poor blood pressure control (pre-dialysis blood pressure ≥180/100) did not differ between urban and rural participants [fully adjusted OR 0.96 (0.36, 2.60)]. CONCLUSIONS Differences in ECFV control do not appear to explain higher mortality among remote- and rural- dwelling hemodialysis patients, compared to urban-dwellers.
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Affiliation(s)
- Marcello Tonelli
- University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Anita Lloyd
- University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Neesh Pannu
- University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Scott Klarenbach
- University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Pietro Ravani
- University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Kailash Jindal
- University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Jennifer MacRae
- University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Larry Unsworth
- University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Braden Manns
- University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Brenda Hemmelgarn
- University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
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Earthman CP. Body Composition Tools for Assessment of Adult Malnutrition at the Bedside: A Tutorial on Research Considerations and Clinical Applications. JPEN J Parenter Enteral Nutr 2016; 39:787-822. [PMID: 26287016 DOI: 10.1177/0148607115595227] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Because of the key role played by the body's lean tissue reserves (of which skeletal muscle is a major component) in the response to injury and illness, its maintenance is of central importance to nutrition status. With the recent development of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition diagnostic framework for malnutrition, the loss of muscle mass has been recognized as one of the defining criteria. Objective methods to evaluate muscle loss in individuals with acute and chronic illness are needed. Bioimpedance and ultrasound techniques are currently the best options for the clinical setting; however, additional research is needed to investigate how best to optimize measurements and minimize error and to establish if these techniques (and which specific approaches) can uniquely contribute to the assessment of malnutrition, beyond more subjective evaluation methods. In this tutorial, key concepts and statistical methods used in the validation of bedside methods to assess lean tissue compartments are discussed. Body composition assessment methods that are most widely available for practice and research in the clinical setting are presented, and clinical cases are used to illustrate how the clinician might use bioimpedance and/or ultrasound as a tool to assess nutrition status at the bedside. Future research needs regarding malnutrition assessment are identified.
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Affiliation(s)
- Carrie P Earthman
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, St Paul, Minnesota
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Kose SB, Hur E, Magden K, Yildiz G, Colak D, Kucuk E, Toka B, Kucuk H, Yildirim I, Kokturk F, Duman S. Bioimpedance spectroscopy for the differential diagnosis of hyponatremia. Ren Fail 2015; 37:947-50. [PMID: 25915455 DOI: 10.3109/0886022x.2015.1040418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Hyponatremia is classified according to volume status with the help of physical examination, biochemical measures, urine and serum osmolalities, and echocardiography. Bioimpedance spectroscopy (BIS) has been getting popularity for revealing tissue compositions of various patient groups. The aim of this observational study was to investigate the role of BIS for the differential diagnosis of hyponatremia (ClinicalTrials.gov Identifier: NCT01838759). PATIENTS AND METHODS Personal characteristics of age, sex, weight, height, and blood pressure were recorded. Body composition monitor (BCM) was used for hydration status for each individual. Primary outcome was investigated by the accuracy of volume status measured by BIS. STATISTICS Kappa statistic (K) is a measure of agreement between two sources, which is measured on a binary scale (i.e., condition present/absent). K statistic can take values between 0 and 1: poor agreement: K < 0.20, fair agreement: 0.2.0-0.3.9, moderate agreement: 0.40-0.59, substantial: 0.60-0.79, very good agreement: 0.80-1.00. RESULTS Fifty-eight hyponatremia-diagnosed patients, 32 (55.2%) of male with the mean age of 65.2 ± 11 (40-89) years were included. Kappa statistic (K) were very good (K = 0.925) for male (p < 0.00), substantial agreement (K = 0.601) for female (p < 0.002) with the use of BIS for the differential diagnosis of either hypo or hypervolemia in hyponatremic patients compared with gold standard tests which were the combination of echocardiography, serum, and urine osmolality biochemical tests, and physical examination. CONCLUSION Bioimpedance spectroscopy is a practical and an inexpensive method. This is the first study in the literature showing the role of BIS for the determination of the volume status and differential diagnosis of hyponatremia when compared with echocardiography.
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Affiliation(s)
- Sennur Budak Kose
- a Nephrology Clinic, Istanbul Education and Research Hospital , Istanbul , Turkey
| | - Ender Hur
- b Division of Nephrology , Bulent Ecevit University , Zonguldak , Turkey
| | - Kemal Magden
- b Division of Nephrology , Bulent Ecevit University , Zonguldak , Turkey
| | - Gursel Yildiz
- c Nephrology Clinic, Ataturk State Hospital , Zonguldak , Turkey
| | | | | | | | | | - Ibrahim Yildirim
- b Division of Nephrology , Bulent Ecevit University , Zonguldak , Turkey
| | - Furuzan Kokturk
- g Department of Biostatistics , Bulent Ecevit University , Zonguldak , Turkey , and
| | - Soner Duman
- h Department of Internal Medicine , Ege University , Izmir , Turkey
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Affiliation(s)
- Urvashi Mulasi
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, Minnesota
| | - Adam J. Kuchnia
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, Minnesota
| | - Abigail J. Cole
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, Minnesota
| | - Carrie P. Earthman
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, Minnesota
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11
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Sawant A, House AA, Chesworth BM, Connelly DM, Lindsay R, Gati J, Bartha R, Overend TJ. Association between muscle hydration measures acquired using bioelectrical impedance spectroscopy and magnetic resonance imaging in healthy and hemodialysis population. Physiol Rep 2015; 3:e12219. [PMID: 25626863 PMCID: PMC4387764 DOI: 10.14814/phy2.12219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 09/08/2014] [Accepted: 09/11/2014] [Indexed: 11/24/2022] Open
Abstract
Establishing the effect of fluctuating extracellular fluid (ECF) volume on muscle strength in people with end-stage renal disease (ESRD) on hemodialysis (HD) is essential, as inadequate hydration of the skeletal muscles impacts its strength and endurance. Bioelectrical impedance spectroscopy (BIS) has been a widely used method for estimating ECF volume of a limb or calf segment. Magnetic resonance imaging (MRI)-acquired transverse relaxation times (T2) has also been used for estimating ECF volumes of individual skeletal muscles. The purpose of this study was to determine the association between T2 (gold standard) of tibialis anterior (TA), medial (MG), and lateral gastrocnemius (LG), and soleus muscles and calf BIS ECF, in healthy and in people with ESRD/HD. Calf BIS and MRI measures were collected on two occasions before and after HD session in people with ESRD/HD and on a single occasion for the healthy participants. Linear regression analysis was used to establish the association between these measures. Thirty-two healthy and 22 participants on HD were recruited. The association between T2 of TA, LG, MG, and soleus muscles and ratio of calf BIS-acquired ECF and intracellular fluids (ICF) were: TA: β = 0.30, P > 0.05; LG: β = 0.37, P = 0.035; MG: β = 0.43, P = 0.014; soleus: β = 0.60, P < 0.001. For the HD group, calf ECF was significantly associated with T2 of TA (β = 0.44, P = 0.042), and medial gastrocnemius (β = 0.47, P = 0.027) following HD only. Hence BIS-acquired measures cannot be used to measure ECF volumes of a single muscle in the ESRD/HD population; however, BIS could be utilized to estimate ratio of ECF: ICF in healthy population for the LG, MG, and soleus muscles.
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Affiliation(s)
- Anuradha Sawant
- Western University, London, Ontario, Canada
- London Health Sciences Center, University Hospital Campus, London, Ontario, Canada
| | - Andrew A. House
- Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Bert M. Chesworth
- Department of Epidemiology and Biostatistics, School of Physical Therapy, Western University, London, Ontario, Canada
| | | | - Robert Lindsay
- Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Joe Gati
- The Centre for Functional and Metabolic Mapping, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Robert Bartha
- The Centre for Functional and Metabolic Mapping, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Tom J. Overend
- School of Physical Therapy, Western University, London, Ontario, Canada
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Probing the dry weight by bioimpedance: the resistance stabilization test. J Nephrol 2014; 28:517-20. [PMID: 25480486 DOI: 10.1007/s40620-014-0159-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
Probing dry weight (DW) was largely dependent on clinical subjective estimate until recently. New bedside non-invasive tools have been developed with the aim of providing more objective information on volume status and guiding physicians in the quest for DW. Among them, bioimpedance appears to be very promising in the achievement of this goal. We have developed a test aimed to assess DW in complicated hemodialysis (HD) patients and named it "RE.sistance S.tabilization T.est" (RE.S.T.). It is based on the following four items: 1. one or more HD sessions lasting 6 h with ultrafiltration (UF) rate ≤0.5 kg/h are planned; 2. bioimpedance measurements are determined injecting 800 μA at 50 kHz alternating sinusoidal current with a standard tetrapolar technique. Resistance (R) is recorded at the start of the treatment (R0) and every 15 min (Rt) during HD until the end of the 6-h session; 3. DW is defined as that achieved at the time point at which three consecutive R0/Rt ratios show in-between changes ±1% despite ongoing UF; 4. if at the end of the 6-h HD session R stabilization is not attained, a new 6-h HD treatment with UF rate ≤0.5 kg/h is planned until a bioimpedance DW (according to the item 3) is obtained. As said, we are applying RE.S.T. to assess DW in complicated HD patients. Here we report a paradigmatic case which illustrates quite brilliantly its clinical usefulness. The patient was admitted to our nephrology ward with a hypertensive crisis, a very large drug regimen notwithstanding. His DW was reduced by 5 kg after four 6-h HD sessions probing his DW by means of RE.S.T. He was discharged with a normal blood pressure and no need for anti-hypertensive drugs. In conclusion, RE.S.T. appears to be a (the) brilliant solution in solving the old problem of DW in HD patients.
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Water removal from the legs does explain hypotension in short daily hemodialysis. Int Urol Nephrol 2014; 46:1683-4. [PMID: 24700410 DOI: 10.1007/s11255-014-0706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
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Onofriescu M, Hogas S, Voroneanu L, Apetrii M, Nistor I, Kanbay M, Covic AC. Bioimpedance-guided fluid management in maintenance hemodialysis: a pilot randomized controlled trial. Am J Kidney Dis 2014; 64:111-8. [PMID: 24583055 DOI: 10.1053/j.ajkd.2014.01.420] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 01/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic subclinical volume overload happens very frequently in hemodialysis patients and is associated directly with hypertension, increased arterial stiffness, left ventricular hypertrophy, and ultimately higher mortality. STUDY DESIGN Randomized controlled parallel-group trial. SETTING & PARTICIPANTS 131 patients from one hemodialysis center, randomly assigned into 2 groups. INTERVENTION Dry weight prescription using results derived from repeated 3-month bioimpedance measurements to guide ultrafiltration for strict volume control (bioimpedance group; n=62) compared with clinical judgment without bioimpedance measures (clinical-methods group; n=69) for 2.5 years. OUTCOMES The primary outcome was all-cause mortality over 2.5 years (the duration of the intervention). Secondary outcomes were change in relative arterial stiffness, fluid overload, and blood pressure (BP) over 2.5 years. MEASUREMENTS Bioimpedance measurements were performed using a Body Composition Monitor device. Pulse wave velocity analysis was performed at baseline, 2.5 years (end of intervention), and 3.5 years (end of study). Relative fluid overload and BP were assessed at 3-month intervals. RESULTS The unadjusted HR for all-cause death in the bioimpedance group (vs the clinical-methods group) was 0.100 (95% CI, 0.013-0.805; P=0.03). After 2.5 years, we found a greater decline in arterial stiffness, relative fluid overload, and systolic BP in the bioimpedance group than the clinical-methods group. Between-group differences in change from baseline to the end of intervention were -2.78 (95% CI, -3.75 to 1.80)m/s for pulse wave velocity (P<0.001), -2.99% (95% CI, -5.00% to -0.89%) for relative fluid overload (P=0.05), and -2.43 (95% CI, -7.70 to 2.84)mmHg for systolic BP (P=0.4). LIMITATIONS Echocardiography was not performed as cardiovascular assessment and the caregivers were not masked to the intervention. CONCLUSIONS Our study showed improvement in both surrogate and hard end points after strict volume control using bioimpedance to guide dry weight adjustment. These findings need to be confirmed in a larger trial.
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Affiliation(s)
- Mihai Onofriescu
- Nephrology Department, "Dr. C.I. Parhon" University Hospital, University of Medicine and Pharmacy "Gr. T. Popa," Iasi, Romania.
| | - Simona Hogas
- Nephrology Department, "Dr. C.I. Parhon" University Hospital, University of Medicine and Pharmacy "Gr. T. Popa," Iasi, Romania
| | - Luminita Voroneanu
- Nephrology Department, "Dr. C.I. Parhon" University Hospital, University of Medicine and Pharmacy "Gr. T. Popa," Iasi, Romania
| | - Mugurel Apetrii
- Nephrology Department, "Dr. C.I. Parhon" University Hospital, University of Medicine and Pharmacy "Gr. T. Popa," Iasi, Romania
| | - Ionut Nistor
- Nephrology Department, "Dr. C.I. Parhon" University Hospital, University of Medicine and Pharmacy "Gr. T. Popa," Iasi, Romania
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Adrian C Covic
- Nephrology Department, "Dr. C.I. Parhon" University Hospital, University of Medicine and Pharmacy "Gr. T. Popa," Iasi, Romania
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Matthie JR. Bioimpedance measurements of human body composition: critical analysis and outlook. Expert Rev Med Devices 2014; 5:239-61. [DOI: 10.1586/17434440.5.2.239] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kraemer M. Physiological monitoring and control in hemodialysis: state of the art and outlook. Expert Rev Med Devices 2014; 3:617-34. [PMID: 17064247 DOI: 10.1586/17434440.3.5.617] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Medical devices for monitoring and feedback control of physiological parameters of the dialysis patient were introduced in the early 1990s. They have a wide range of applications, aiming at increasing the safety and ensuring the efficiency of the treatment, and at an improved restoration of physiological conditions, leading to an overall reduction in morbidity and mortality. Such devices include sensors for the measurement of temperature, optical parameters and sound speed in blood, and electrical characteristics of the human body, and other parameters. Essential for the development of these devices is a detailed understanding of the pathophysiological background of a therapeutical problem. There is still a large potential to introduce new devices for further therapy improvement and automation. Also, the size of the hemodialysis market appears attractive; however, a new product has to meet several specific requirements in order to also become commercially successful. This review describes the therapeutic and technical principles of several available devices, reports on concepts for possible future devices, and presents a short overview on the market environment.
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Affiliation(s)
- Matthias Kraemer
- Fresenius Biotech GmbH, Borkenberg 14, 61440 Oberursel, Germany.
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Kocyigit I, Sipahioglu MH, Orscelik O, Unal A, Celik A, Abbas SR, Zhu F, Tokgoz B, Dogan A, Oymak O, Kotanko P, Levin NW. The association between arterial stiffness and fluid status in peritoneal dialysis patients. Perit Dial Int 2014; 34:781-90. [PMID: 24385328 DOI: 10.3747/pdi.2013.00057] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES In this study our aim was to evaluate the relationship between degree of fluid status and arterial stiffness measured by pulse wave velocity (PWV) in peritoneal dialysis (PD) patients. Fluid status was determined by different methods including fluid overload measured by bioimpedance (Body Composition Monitor, BCM), calf normalized resistivity (CNR), plasma N-terminal fragment of B-type natriuretic peptide (NT-proBNP) and extracellular to intracellular water ratio (ECW/ICW). METHODS Sixty PD patients were evaluated. They were stratified into normo- and hypervolemic groups according to their fluid overload (FO). CNR was calculated from resistance at 5 kHz using calf bioimpedance spectroscopy. Arterial stiffness was assessed by PWV. Additionally, all patients underwent transthoracic echocardiography and had levels of NT-proBNP measured. RESULTS PWV was higher in the hypervolemic compared to normovolemic patients (9.99 ± 2.4 m/sec vs 7.48 ± 2.3 m/sec, p < 0.001). Hypervolemic patients had higher NT-proBNP levels (3065 ± 981 pg/mL vs 1095 ± 502 pg/mL, p < 0.001), a higher ratio of ECW/ICW; (0.93 ± 0.11 vs 0.81 ± 0.08, p < 0.001) and lower CNR (13.7 ± 2.4 vs 16.0 ± 3.3 W m(3)/kg(*)10(-2), p = 0.005). NT-pro BNP level, ECW/ICW ratio, relative FO, and left ventricular (LV) mass index were positively and CNR negatively correlated with PWV. Relative FO and CNR independently predicted PWV in multivariate analysis adjusted for age, duration of PD, body mass index and mean arterial pressure. CONCLUSIONS Arterial stiffness is increased in fluid-overloaded PD patients. Our results indicated that fluid status is an independent predictor of PWV.
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Affiliation(s)
- Ismail Kocyigit
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Murat Hayri Sipahioglu
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Ozcan Orscelik
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Aydin Unal
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Ahmet Celik
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Samer R Abbas
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Fansan Zhu
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Bulent Tokgoz
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Ali Dogan
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Oktay Oymak
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Peter Kotanko
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
| | - Nathan W Levin
- Erciyes University Medical Faculty, Department of Nephrology, Kayseri, Turkey; Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey; and Renal Research Institute, New York City, NY, USA
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Seibert E, Zhu F, Kuhlmann MK, Henson R, Oribello AM, Girndt M, Kotanko P, Levin NW. Slope analysis of blood volume and calf bioimpedance monitoring in hemodialysis patients. Nephrol Dial Transplant 2012; 27:4430-6. [DOI: 10.1093/ndt/gfr734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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LIU LI, ZHU FANSAN, G RAIMANN JOCHEN, THIJSSEN STEPHAN, SIPAHIOGLU MURATH, WYSTRYCHOWSKI GREGORY, KITZLER THOMAS, TETTA CIRO, WABEL PETER, KOTANKO PETER, LEVIN NATHANW. Determination of fluid status in haemodialysis patients with whole body and calf bioimpedance techniques. Nephrology (Carlton) 2012; 17:131-40. [DOI: 10.1111/j.1440-1797.2011.01526.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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20
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Aspromonte N, Cruz DN, Ronco C, Valle R. Role of Bioimpedance Vectorial Analysis in Cardio-Renal Syndromes. Semin Nephrol 2012; 32:93-9. [DOI: 10.1016/j.semnephrol.2011.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Urea kinetics and intermittent dialysis prescription in small animals. Vet Clin North Am Small Anim Pract 2011; 41:193-225. [PMID: 21251518 DOI: 10.1016/j.cvsm.2010.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hemodialysis improves survival for animals with acute kidney injury beyond what would be expected with conventional management of the same animals. Clinical evidence and experience in human patients suggest a role for earlier intervention with renal replacement to avoid the morbidity of uremia and to promote better metabolic stability and recovery. For a large population of animal patients, it is the advanced standard for the management of acute and chronic uremia, life-threatening poisoning, and fluid overload for which there is no alternative therapy.
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Lee SW, Kim DY, Lee SH, Cho HC, Kwon SH, Song JH, Kim MJ. New method of predicting dry weight using bioelectrical impedance analysis in haemodialysis patients. Nephrology (Carlton) 2009; 14:705-11. [PMID: 20025677 DOI: 10.1111/j.1440-1797.2009.01123.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM There were significant differences in the slopes of the ultrafiltration (UF) amount removed during haemodialysis (HD) sessions versus the percentage change in the extracellular fluid/total body water ratio for the right lower extremity (ECF/TBW(right leg)) plot in normohydrated (NH) and overhydrated states. The purpose of this study was to develop and validate a method for predicting dry weight (DW) using these results. METHODS It was hypothesized that for patients to become NH, the slope of the UF amount versus the percentage changes in ECF/TBW(right leg) plot should be same as that of NH patients and a method for predicting DW was developed. To validate the accuracy of this method, the ECF/TBW(right leg) was measured by eight-point tactile-electrode bioelectrical impedance analysis before and after HD in 17 newly enrolled NH patients. Using the current DW (cDW) of subjects as a reference, we compared the accuracies of pDW1 (our devised method) and pDW2 (the normovolaemia/hypervolaemia slope method). RESULTS The mean cDW, pDW1 and pDW2 values were 56.8 +/- 7.9, 56.4 +/- 7.7 and 56.3 +/- 8.0 kg, respectively. No significant differences existed between cDW, pDW1 and pDW2. pDW1 had a lower root mean square error than pDW2 (1.12 vs 1.69). On the Bland-Altman plot, differences between pDW1 and cDW were closer to zero than between pDW2 and cDW. CONCLUSION A new method was developed of predicting the DW using the relationship between the UF amount and the percentage change in the ECF/TBW ratio of the lower extremities after HD. The devised method appears to be as accurate as the normovolaemia/hypervolaemia slope method.
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Affiliation(s)
- Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Kidney Disease Research Group, Inha University College of Medicine, Incheon, Korea
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Zhu F, Kuhlmann MK, Kotanko P, Seibert E, Leonard EF, Levin NW. A method for the estimation of hydration state during hemodialysis using a calf bioimpedance technique. Physiol Meas 2008; 29:S503-16. [DOI: 10.1088/0967-3334/29/6/s42] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Freiberger M, Brunner P, Mayer M, Surkhi OI, Riu PJ, Scharfetter H. Indicator for hydration balance during haemodialysis based on anisotropic FEM. Physiol Meas 2008; 29:S479-89. [DOI: 10.1088/0967-3334/29/6/s40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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26
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LEE SEOUNGWOO, PARK GEUNHO, LEE SEUNGWON, UM WOOKHYUN, KWON SUHYUN, SONG JOONHO, KIM MOONJAE. Different pattern of fluid loss from the lower extremities in normohydrated and overhydrated stage 5 chronic-kidney-disease patients after haemodialysis. Nephrology (Carlton) 2008; 13:109-15. [DOI: 10.1111/j.1440-1797.2007.00832.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jain AK, Lindsay RM. Intra and Extra Cellular Fluid Shifts During the Inter Dialytic Period in Conventional and Daily Hemodialysis Patients. ASAIO J 2008; 54:100-3. [DOI: 10.1097/mat.0b013e318162c404] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Peixoto AJ. Guest Editor: Rajiv Agarwal: Can “Diagnostic Markers” Predict Blood Pressure Response in Hypertensive Dialysis Patients? Semin Dial 2007; 20:411-5. [PMID: 17897247 DOI: 10.1111/j.1525-139x.2007.00315.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Aldo J Peixoto
- Department of Medicine, Division of Nephrology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Connecticut, USA.
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Abstract
Attainment of dry weight remains a major clinical problem and challenge in current-day dialysis therapies. The vicious cycle of fluid overload and inadequate intradialytic fluid removal with hypotensive episodes, and subsequent poor clinical outcomes, is reinforced by excessive salt accumulation orally as well as during dialysis. Negligence in recognizing the importance of fluid status in dialysis prescriptions with shortened times has contributed to the prevalence of overhydration. The treatment of this problem is exacerbated by the lack of adequate methods to diagnose and manage it. The recent findings of improved fluid status and prognosis with salt restriction, individualized dialysate sodium concentrations, and prolonged hemodialysis times when necessary with well-tolerated fluid removal rates show the path to prolonging survival of dialysis populations. The ongoing development of techniques permitting accurate assessment of hydration status, including those based on bioimpedance analysis, will provide an efficient tool in these efforts.
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Basile C, Vernaglione L, Di Iorio B, Bellizzi V, Chimienti D, Lomonte C, Rubino A, D'Ambrosio N. Development and Validation of Bioimpedance Analysis Prediction Equations for Dry Weight in Hemodialysis Patients. Clin J Am Soc Nephrol 2007; 2:675-80. [PMID: 17699481 DOI: 10.2215/cjn.00240107] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Accurate assessment of hydration status and specification of dry weight (DW) are major problems in the clinical treatment of hemodialysis (HD) patients. Bioelectrical impedance analysis (BIA) has been recognized as a noninvasive and simple technique for the determination of DW in HD patients. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS This study was designed to develop and validate BIA prediction equations for DW in HD patients. It included white adults (1540 disease-free adults with normal body mass index [BMI] and 456 prevalent and 27 incident HD patients). All participants underwent at least one single-frequency BIA measurement (800 muA and 50 kHz alternating sinusoidal current with a standard tetrapolar technique). The BIA variable measured was resistance (R). Data of 1463 (95% of the cohort) disease-free individuals with normal BMI (prediction sample) were used to establish best-fitting BIA prediction equations of body weight. The latter were cross-validated in the residual 5% subset (77 individuals) of the same cohort (validation sample). RESULTS Multiple regression analysis showed a significant relationship among body weight, R, age, and height in 739 men (R(2) = 0.82, P < 0.0001) and among body weight, R, and height in 724 women (R(2) = 0.68, P < 0.0001) in the prediction sample. The Bland Altman analysis showed a mean difference between predicted and measured body weight of 0.3 +/- 1.0 kg (95% confidence interval +/- 2.0 kg) in the validation sample. The BIA prediction equations that were obtained in disease-free individuals with normal BMI were applied to a cohort of 456 prevalent HD patients: The mean difference between achieved and estimated DW was 0.1 +/- 1.0 kg (P = 0.53) in men and -0.3 +/- 1.0 (P = 0.76) in women. Finally, BIA prediction equations were tested in a cohort of 27 incident HD patients. The mean difference between predicted and achieved DW was -0.6 +/- 1.0 kg (P = 0.76) in men and 0.6 +/- 1.0 (P = 0.50) in women. CONCLUSIONS This study was able to develop and validate BIA prediction equations for DW in HD patients. They seem to be a promising tool; however, they still need external validation.
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Affiliation(s)
- Carlo Basile
- Nephrology and Dialysis Units, Miulli General Hospital, Italy.
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Abstract
The total amount of sodium present in the body controls the extracellular volume. In advanced renal failure, sodium balance becomes positive and the extracellular volume expands. This leads to hypertension, and vascular changes that lead to adverse cardiovascular consequences in dialysis patients. Controlling the body sodium content and the extracellular volume allows one to better control hypertension and its consequences. This can be achieved by reducing the sodium input (sodium dietary restriction and reasonably low sodium dialysate) and/or by increasing the sodium output (ultrafiltration by convection). The discontinuous nature of hemodialysis causes saw-tooth volume fluctuations. This has led to the concept of dry weight (DW), a crucial component of dialysis adequacy. Assessment and achievement of DW is feasible on pure clinical grounds. But its relative lack of accuracy (and the physicians' progressive lack of interest in bedside examination) has led to several nonclinical methods of assessing DW in an effort to improve the assessment of fluid status in dialysis patients.
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Sarkar SR, Kotanko P, Levin NW. Fellows' Forum in Dialysis: Interdialytic Weight Gain: Implications in Hemodialysis Patients. Semin Dial 2006; 19:429-33. [PMID: 16970745 DOI: 10.1111/j.1525-139x.2006.00199_1.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Interdialytic weight gain (IDWG) is an easily measurable parameter in the dialysis unit, routinely assessed at the beginning of the dialysis session. It is used along with clinical symptoms and signs and predialysis blood pressure readings to make decisions regarding the amount of fluid removal during a dialysis session. IDWG is also used as a basis for fluid and salt intake recommendations. However, advising fluid and salt restriction based solely on IDWG may not be appropriate because of its status as a nutritional indicator, as well. Very few studies have been designed to determine the direct effect of IDWG on morbidity and mortality. Any such effect is confounded by residual renal function and various comorbidities, the effects of which might be difficult to separate from those of IDWG. Most attempts to control IDWG have concentrated on requiring patients to reduce fluid and dietary salt intake. Although there does not seem to be a consensus at this point, it is likely that within the lower values of IDWG (less than 5.7% of dry weight), tighter control of fluid and salt intake might not be warranted since these values may reflect higher protein and calorie intake, indicating better nutritional status.
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Affiliation(s)
- Shubho R Sarkar
- Renal Research Institute and Beth Israel Medical Center, New York, New York 10128, USA
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Abstract
The value of bioimpedance in hemodialysis remains under debate. However, when appropriately used, bioimpedance can provide measures of body hydration characterized by a small error, a high sensitivity to changes in water volume, and, above all, a linear relationship over a wide range of volume changes. These features make it very useful to measure body hydration in hemodialysis patients.
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Affiliation(s)
- D Schneditz
- Institute of Physiology, Center for Physiologic Medicine, Medical University of Graz, Graz, Austria.
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Zhu F, Leonard EF, Carter M, Levin NW. Continuous measurement of calf resistivity in hemodialysis patients using bioimpedance analysis. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2006; 2006:5126-5128. [PMID: 17946679 DOI: 10.1109/iembs.2006.260156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study demonstrates a technique to measure electrical resistivity of the calf in hemodialysis (HD) patients during HD treatment. To continuously monitor and calculate resistivity, a model of calf volume based on its geometrical size and measurement of its electrical resistance has been developed. The model makes it possible to continuously estimate reduction of the calf circumference during HD. Seventeen HD patients were studied during HD using a multi-frequency bioimpedance device (Xitron 4200). Circumference of the calf was measured by a measuring tape pre- and post- HD for each treatment. Results showed a high correlation between measurement and calculation circumference in post HD (r(2)=0.985). Further, the value of resistivity normalized by body mass index (BMI) provides information about patients' hydration state in comparison to those in healthy subjects. This technique is useful for identifying the range of optimal hydration states for HD patients.
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Affiliation(s)
- Fansan Zhu
- Renal Research Institute, New York, NY, USA
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Kuhlmann MK, Zhu F, Seibert E, Levin NW. Bioimpedance, dry weight and blood pressure control: new methods and consequences. Curr Opin Nephrol Hypertens 2005; 14:543-9. [PMID: 16205473 DOI: 10.1097/01.mnh.0000185983.48319.00] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Chronic overhydration contributes to the development of left ventricular hypertrophy and a high cardiovascular mortality in end-stage renal disease. Assessment of dry weight is highly dependent on clinical assessment. Bioimpedance technology offers the potential to quantify body fluid compartments and to facilitate dry weight prescription. This review covers recent innovative approaches to dry weight assessment using bioimpedance technology. RECENT FINDINGS Three different bioimpedance approaches to determine dry weight have been published. The normovolemic/hypervolemic slope method applies whole body multifrequency bioimpedance to assess predialysis total body extracellular fluid volume and compares the extracellular fluid volume/body weight relation at hypervolemia with the standard value in normovolemic individuals. The resistance-reactance graph method uses whole body single frequency bioimpedance for assessment of hydration state and nutritional status from height-adjusted resistance and reactance. The resulting resistance-reactance vector is set in relation to a distribution range in a normovolemic population. An alternative method uses segmental bioimpedance in the form of continuous intradialytic calf bioimpedance to record changes in calf extracellular volume during dialysis. Dry weight by this method is defined as the weight at which calf extracellular volume is not further reduced despite ongoing ultrafiltration. SUMMARY Although promising, none of these methods has gained much popularity, probably due to the difficulties in understanding bioimpedance and the lack of gold standard methods for dry weight determination. Bioimpedance will improve dry weight assessment, but further refinement of the methods as well as large-scale clinical studies to demonstrate the accuracy and the clinical value of objective dry weight determination are needed.
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Lee SW, Park GH, Lee SY, Song JH, Kim MJ. WHO class-specific equations using height for predicting body weight: crude indicator for dry weight in haemodialysis patients. Nephrology (Carlton) 2005; 10:446-52. [PMID: 16221093 DOI: 10.1111/j.1440-1797.2005.00446.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Body weight (BW) might be related to total body water, and the difference between a patient's actual BW and ideal BW (IBW) might be the volume marker. However, there has been no information about the association between IBW and dry weight (DW) in haemodialysis (HD) patients. METHODS First, we analysed the relationship between DW and IBW in 51 HD patients. The IBW was calculated by 21 x Height (Ht)(2). Weight status was analysed by the WHO classification. Second, in 12 436 controls, linear equations using Ht(2) were sought to predict the BW in each sex and WHO class. Third, using these equations, predicted BW (PW) was compared with DW in each WHO class at the initiation and after 1 year in 619 new HD patients, retrospectively. RESULTS Among 51 HD patients, 38 were normal weight in whom there was no difference between DW and IBW. In each sex and WHO class of the 12 436 controls, linear equations using Ht(2) were developed to predict BW. These equations were applied to 619 new HD patients. In males, there were no differences between PW and DW in underweight (UW), overweight (OW), obese (OB) and extremely obese (EOB) patients at the initiation of the HD. In females, there were no differences between PW and DW in OW patients. Despite no statistical differences, there were wide ranges of distribution from -6 to 6 kg between PW and DW. CONCLUSIONS BW had a linear relationship with Ht(2) and might be predictable by the WHO class-specific equation using Ht(2). These equations might be useful as a crude indicator of DW in HD patients.
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Affiliation(s)
- Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Kidney Disease Research Group, Inha University College of Medicine, Inchon, Korea
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