The impact of hydration status on the assessment of lean body mass by body electrical impedance in dialysis patients.
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The impact of hydration status on body composition analysis in hemodialysis (HD) and peritoneal dialysis (PD) patients was assessed. Twenty-seven HD patients and 42 PD patients were divided into three groups according to their (postdialytic) hydration status as measured by segmental bioelectrical impedance analysis (BIA): normohydrated, dehydrated, or overhydrated. Fifty-six percent of the PD patients and 74% of the HD patients appeared to be normohydrated. Lean body mass (LBM) was calculated in all subjects from skinfold anthropometric (SA) measurements and from whole body BIA data. LBM-SA and LBM-BIA did not differ in normohydrated patients and correlated well with each other (r = 0.88). In overhydrated subjects BIA overestimated LBM compared to SA; in the dehydrated group BIA tended to underestimate LBM. The correlation between LBM-SA and LBM-BIA was poor in both groups. It can be concluded that hydration status has a major influence on BIA-based LBM measurements. Reliable LBM figures can only be obtained when patients are at their ideal dry weight.Keywords:
Bioelectrical Impedance Analysis
Body water
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Protein energy wasting is closely related to increased morbidity and mortality in peritoneal dialysis (PD) patients. Simple reliable and easily available methods of determining nutritional status and recognition of short-term changes in body composition are therefore important for clinical practice.We compared whole-body and segmental composition using multifrequency bioelectrical impedance analysis (MF-BIA) and dual-energy X-ray absorptiometry (DEXA) in 104 stable PD patients.Assessment of whole-body composition showed that lean body mass (LBM) was highly correlated with good method agreement using DEXA as the reference test (r = 0.95, p < 0.0001; bias -0.88 kg, 95% CI -1.53 to 0.23 kg). Similarly, high correlation and good method agreement were found for fat mass (r = 0.93, p < 0.0001; bias 0.69 kg, 95% CI 0.03-1.36 kg). Segmental analysis of LBM revealed strong correlations between LBM for trunk, left and right arms and legs (r = 0.90, 0.84, 0.86, 0.89 and 0.90, respectively, p < 0.0001). Bone mineral content derived by MF-BIA overestimated that measured by DEXA (bias 0.740 kg, 95% CI 0.66-0.82 kg).MF-BIA may potentially be a useful tool for determining nutritional status in PD patients and serial estimations may help recognize short-term changes in body composition.
Bioelectrical Impedance Analysis
Dual-Energy X-ray Absorptiometry
Dual energy
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The impact of hydration status on body composition analysis in hemodialysis (HD) and peritoneal dialysis (PD) patients was assessed. Twenty-seven HD patients and 42 PD patients were divided into three groups according to their (postdialytic) hydration status as measured by segmental bioelectrical impedance analysis (BIA): normohydrated, dehydrated, or overhydrated. Fifty-six percent of the PD patients and 74% of the HD patients appeared to be normohydrated. Lean body mass (LBM) was calculated in all subjects from skinfold anthropometric (SA) measurements and from whole body BIA data. LBM-SA and LBM-BIA did not differ in normohydrated patients and correlated well with each other (r = 0.88). In overhydrated subjects BIA overestimated LBM compared to SA; in the dehydrated group BIA tended to underestimate LBM. The correlation between LBM-SA and LBM-BIA was poor in both groups. It can be concluded that hydration status has a major influence on BIA-based LBM measurements. Reliable LBM figures can only be obtained when patients are at their ideal dry weight.
Bioelectrical Impedance Analysis
Body water
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The state of hydration affects the outcomes of chronic dialysis. Bioelectrical impedance analysis (BIA) provides estimates of body water (V), extracellular volume (ECFV), and fat-free mass (FFM) that allow characterization of hydration. We compared single-frequency BIA measurements before and after 14 hemodialysis sessions in 10 Nigerian patients (6 men, 4 women; 44+/-7 years old) with clinical evaluation (weight removed during dialysis, presence of edema) and with estimates of body water obtained by the Watson, Chertow, and Chumlea anthropometric formulas. Predialysis and postdialysis values of body water did not differ between BIA and anthropometric estimates. However, only the BIA estimate of the change in body water during dialysis (-0.8+/-2.9 L) did not differ from the corresponding change in body weight (-1.3+/-3.0 kg), while anthropometric estimates of the change in body water were significantly lower, approximately one-third of the change in weight. Bioelectrical impedance analysis correctly detected the intradialytic change in body water content (the ratio V/Weight) in 79% of the cases, while anthropometric formula estimates of the same change were erroneous in each case. Compared with patients with clinical postdialysis euvolemia (n=7), those with postdialysis edema (n=5) had higher values of postdialysis BIA ratios V/FFM (0.77+/-0.01 vs. 0.72+/-0.03, p<0.01) and ECFV/V (0.53+/-0.02 vs. 0.47+/-0.06, p<0.05), respectively. Bioelectrical impedance analysis appeared to underestimate body water and extracellular volume in a patient with massive ascites and bilateral pleural effusions. Anthropometric formulas are not appropriate for evaluating the state of hydration in patients on chronic hemodialysis. In contrast, BIA provides estimates of hydration agreeing with clinical estimates in the same patients, although it tends to underestimate body water and extracellular volume in patients with large collections of fluid in central body cavities.
Bioelectrical Impedance Analysis
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Patients on dialysis have important changes in body composition.To determine the correlation between skinfold thickness (SKF) and bioimpedance analysis (BIA) for estimating fat mass (FM) and lean body mass (LBM) in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD).Cross-sectional study. We included 50 patients under dialysis treatment. To measure SKF, we used the Lange® skinfold caliper (Beta Technology, California, USA) and we carried out the impedance analysis with the Bodystat Quadscan 4000® (Quadscan, Isle of Man, UK). The measurements were performed post-hemodialysis. The PD patients were measured with and without peritoneal dialysate and body weight was corrected for peritoneal fluid. We determined the Pearson's correlation coefficient between SKF and BIA for estimating FM and LBM. We also evaluated the influence of age, sex, diuretic use, dialysis vintage, extracellular water (ECW), and intracellular water (ICW) through a multivariate regression analysis.Of the 50-patient total, 29 were men (58%) and patient mean age was 46.3 ± 16.5 years. The correlation between SKF and BIA was r = 0.784 (p < 0.001) for FM and r = 0.925 (p < 0.001) for LBM. Age and sex influenced the variability of FM, whereas sex, age, and ECW influenced the variability of LBM, both evaluated through the SKF and BIA methods.SKF and BIA are useful methods in clinical practice. The strong and statistically significant correlations between the two methods show they are interchangeable. Age, sex, ECW, and ICW influence the variability of FM and LBM.
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Dialysis adequacy
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Background . To assess the effect of duration of hemodialysis therapy on the body composition of patients with chronic kidney disease stage 5. To study the cumulative survival of patients receiving chronic hemodialysis therapy, depending on changes in their body composition and nutritional status. Patients and methods. 84 patients with terminal kidney disease from one hemodialysis center were observed for two years. Diamant-AIST device was used for the evaluation of the compartments' volumes and nutritional status. Results. Negative correlations between the time on the hemodialysis treatment and studied bioelectrical impedance analysis parameters were observed: correlation with total fluid volume (r=-0,6, p<0,05), fat free mass (r=-0,558, p<0,05), free water volume (r=-0,588, p<0,05), fat mass (r=-0,458, p<0,05), lean body mass (r=-0,564, p<0,05), active cell mass (r=-0,5, p<0,05). There was a statistically significant difference between the cumulative survival with regard to mortality from all causes and cardiovascular events of the patients with high and low values of the fat body mass. Conclusions. Our study showed that change in the compartment's volumes is associated with the length of hemodialysis treatment. There is a statistically significant difference in survival of patients with low and high free fat mass.
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Background: It is essential to define dry weight (DW) for each patient in clinical dialysis, but many patient remain with fluid overload even in clinical DW. Currently, bioelectrical impedance analysis (BIA) can accurately measure the compostition of different body fluid compartments. The present study was conducted to investigate the body fluid compartment by BIA in dialysis patients.
Materials and Methods: Ninety three dialysis patients including 56 hemodialysis (HD) patients and 37 continuous ambulatory peritoneal dialysis (CAPD) patients and thirty six sex and age matched controls have underwent BIA measurement. The dry weight of dialysis patients was adjusted DW by nephrologists weekly. BIA was performed with a multifrequency bioimpedance analyzer (InBody 3.0(subscript TM), Biospace Co. Ltd. U.S.A). Both pre- and post-hemodialysis measurement were performed in hemodialysis patients. Body weight (BW), total body water (TBW), extracellular fluid (ECF) and intracellular fluid (ICF) were measured. For furthere evaluation, the dialysis patients were divided into edematous and nonedemaous group based on ECF/TBW ratio greater or less than 0.35.
Results: There was no significant difference of TBW/BW ratio between dialysis groups or between dialysis groups and control group. Eventhough there was no difference of ECF/TBW between HD group and CAPD group, there was significant difference between HD groups and control group (HD 0.342±0.004 vs control 0.328±0.002, p＜0.05). There were significant difference of ECF/TBW and ICF/ECF ratio either between edematous group and nonedematous group (p＜0.05) or between edematous group and normal controls (p＜0.05), but no difference between non-edematous group and normal control or between edematous group and normal controls (p＜0.05). Interestingly, there were no significant relationships between TBW/BW and ECF/TBW.
Conclusions: BIA is an appropriate noninvasive method for DW determination and the ECF/TBW and ICF/ECF ratio was more accurate than TBW/BW ratio to evaluate the optimal DW in dialysis patient.
Bioelectrical Impedance Analysis
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Body fluid
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Some anthropometric measurements are usually used to estimate the nutritional status of dialysis patients. The aim of our study was the comparison of some anthropometric measurements in patients adequately (from the clinical point of view) treated with peritoneal dialysis (PD) and hemodialysis (HD). The study was performed on 40 chronic dialysis (both: PD and HD), non-diabetic patients, without any inflammatory process. The patients were divided into two groups, 20 patients in each: I peritoneal dialysis patients (PD-pts), II--hemodialysis patients (HD-pts). In each patient body mass index (BMI), total body water (TBW), lean body mass (LBM), fat body mass (FBM), upper limb musculature (ULM), mid arm circumference in tension and in rest MAC-t and MAC-r), triceps skinfold thickness (TSF) and dialysis index (Kt/V) were determined. The obtained values were analyzed statistically and compared between the groups. In peritoneal dialysis the patients' higher values of BMI, FBM, MAC and TSF (p 0.05). Mean Kt/V values observed were as follows: 2.16 +/- 0.48 in PD patients vs 1.05 +/- 0.35 in the HD patients; (p < 0.01). We conclude that adequately treated, from the clinical point of view the PD patients had better anthropometric indicators of nutritional status than the adequately treated HD patients.
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Bioimpedance analysis is a reliable technique for determining post dialysis target weight. Using this technique, we can understand body fluid status easier and conveniently. Moreover this technique can be used for check nutrition status and nutritional status of dialysis patients. We compared the body fluid status and nutrition status between hemodialysis (HD) patients and peritoneal dialysis (PD) patients by BCM (Body composition monitor) technique. We studied 48 (30 males and 18 females) PD patients, 21 (10 males and 11 females) HD patients. Body composition monitoring (BCM, Fesenitus Medical Care, Germany) was used as a tool for the analysis of bioimpedance. Extracellular water, Total body water, Intracellular water, Overhydration, E/I, Lean tissue mass, Fat Tissue mass was measured and those results were compared between two groups. HD patients were more hydrated than PD patients (61.9% vs. 35.4%) and nutritional status such as LTI was poorer than peritoneal dialysis patients (11.7±1.7 vs. 15.3±2.6). Although total body water is more abundant in peritoneal patients (29.4±5.5L vs. 35.9±6.2L), Extracellular water and intracellular water ratio was relatively higher in Hemodialysis patients (E/I 0.98±0.13 vs. 0.87±0.12). The nutrition status was better in PD patients by comparing the percent of lean tissue mass (LTM%) between two groups (LTM% 52.1±10.6% vs. 66.8±11.3). In conclusions, Hemodialysis patients were more hydrated with poorer nutrition status than peritoneal dialysis patients, but, due to the significant difference of age between two groups, further study should be required.
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