Accuracy of Bioimpedance Modalities for Fluid Assessment in Hemodialysis Patients: A Randomized Observational Study
DOI:
https://doi.org/10.17140/NPOJ-6-124Keywords:
Body composition/physiology; Body fluid/physiology; Electric impedance; Extracellular fluid/metabolism; Renal dialysisAbstract
Aim
Fluid overload is a major contributor to mortality in critically ill patients but is difficult to estimate clinically. Bioimpedance has
been used to estimate fluid volumes with three different methods of analysis:1. single-frequency; 2. multi-frequency; 3. bioimpedance spectroscopy. The aim of this study is to assess the accuracy of different types of bioimpedance analysis in detecting changes
in fluid volumes.
Methods
Prospective observational study, in end-stage renal disease patients requiring dialysis, in a tertiary care center. During hemodialysis, we assessed the correlation between change in estimated total body water volumes, as measured by all three methods of
bioimpedance, and fluid volumes removed, as measured by changes in body weight.
Results
Twenty-four pediatric and adult patients were included in the study (median age 42.4 years) with a total of 30 study assessments
performed. There was a weak correlation between change in body weight and change in estimated total body water volumes
(R=0.15, 0.41, and 0.38, respectively). In the Bland-Altman analysis, the mean biases along with their associated 95% confidence
limits of agreement were -0.23 L (-4.1 to 3.5 L) for single-frequency; -1.1 L (-4.1 to 1.9 L) for multi-frequency; and -0.6 L (-6.1 to
4.8 L) for bioimpedance spectroscopy.
Conclusion
In this study of end-stage renal disease patients requiring dialysis, the accuracy of bioimpedance measurement to evaluate fluid
changes was poor, regardless of bioimpedance modality.
References
Vincent JL, Sackr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European Intensive Care Units: Results of the SOAP study. Crit Care Med. 2006; 34: 344-353. doi: 10.1097/01. 6 John JC et al ccm.0000194725.48928.3a
Sutherland SM, Zappitelli M, Alexander SR, Ranieri VM, Reinhart K, Gerlach H, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: The prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010; 55(2): 316-325. doi: 10.1097/01. ccm.0000194725.48928.3a
Fields DA, Goran MI, McCrory MA. Body-composition assessment via air-displacement plethysmography in adults and children: A review. Am J Clin Nutr. 2002; 75(3): 453-467. doi: 10.1093/ajcn/75.3.453
Shizgal, HM. Nutritional assessment with body composition measurements. JPEN J Parenter Enteral Nutr. 1987; 11: 42-47. doi: 10.1177/014860718701100504
Testani JM, Brisco MA, Kociol RD, Jacoby D, Bellumkonda L, Parikh CR, et al. Substantial discrepancy between fluid and weight loss during acute decompensated heart failure treatment. Am J Med. 2015; 128(7): 776-783. doi: 10.1016/j.amjmed.2014.12.020
Kalantari K, Chang JN, Ronco C, Rosner MH. Assessment of intravascular volume status and volume responsiveness in critically ill patients. Kidney Int. 2013; 83: 1017-1028. doi: 10.1038/ ki.2012.424
Khalil SF, Mohktar MS, Ibrahim F. The theory and fundamentals of bioimpedance analysis in clinical status monitoring and diagnosis of diseases. Sensors (Basel). 2014; 14: 10895-10928. doi: 10.3390/s140610895
Brooks ER, Fatallah-Shayk SA, Langman CB, Wolf KM, Price HE. Bioelectric impedance predicts total body water, blood pressure, and heart rate during hemodialysis in children and adolescents. J Ren Nutr. 2008; 18(3): 304-311. doi: 10.1053/j. jrn.2007.11.008
Torterüe X, Dehoux L, Macher MA, Niel O, Kwon T, Deschênes G, et al. Fluid status evaluation by inferior vena cava diameter and bioimpedance spectroscopy in pediatric chronic hemodialysis. BMC Nephrol. 2017; 18: 373.
Hur E, Usta M, Toz H, Asci G, Wabel P, Kahvecioglu S, et al. Effect of fluid management guided by bioimpedance spectroscopy on cardiovascular parameters in hemodialysis patients: A randomized controlled trial. Am J Kidney Dis. 2013; 61(6): 957-965. doi: 10.1053/j.ajkd.2012.12.017
Yamada Y, Watanabe Y, Ikenaga M, Yokoyama K, Yoshida T, Morimoto T, et al. Comparison of single- or multifrequency bioelectrical impedance analysis and spectroscopy for assessment of appendicular skeletal muscle in the elderly. J Applied Physiol. 1985; 115(6): 812-818. doi: 10.1152/japplphysiol.00010.2013
Venkataraman R, Ranganathan L, Nirmal V, Kameshwaran J, Sheela CV, Renuka MV, et al. Height measurement in the critically Observational Study | Volume 6 | Number 1| Ill patient: A tall order in the critical care unit. Indian J Crit Care Med. 2015; 19(11): 665-668. doi: 10.4103/0972-5229.169342
Bland JM, Altman DG. Comparing methods of measurement: why plotting difference against standard method is misleading. Lancet.1995; 346: 1085-1087. doi: 10.1016/s0140-6736(95)91748-9
Giavarina D. Understanding bland altman analysis. Biochem Med (Zagreb). 2015; 25(2): 141-151. doi: 10.11613/BM.2015.015
Dou Y, Zhu F, Kotanko P. Assessment of extracellular fluid volume and fluid status in hemodialysis patients: Current status Submit your article to this journal | https://openventio.org/submit-manuscript/ Observational Study | Volume 6 | Number 1| John JC et al and technical advances. Sem Dial. 2012; 25(4): 377-387. doi: 10.1111/j.1525-139X.2012.01095.x
Hannan W, Cowen S, Plester C, Fearon K, DeBeau A. Comparison of bioimpedance spectroscopy and multifrequency bioimpedance analysis for the assessment of extracellular and total body water in surgical patients. Clin Sci. 1995; 80: 651-658. doi: 10.1042/cs0890651
Ho L, Kushner R, Schoeller D, Gudivaka R, Spiegel D. Bioimpedance analysis of total body water in hemodialysis patients. Kidney Int. 1994; 46(5): 1438-1442. doi: 10.1038/ki.1994.416
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