Validation of bioelectrical impedance analysis for assessing dry weight of dialysis patients in Pakistan (original) (raw)
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Journal of Contemporary Medicine, 2019
Kronik hemodiyaliz hastalarında sıvı volüm durumunun değerlendirilmesinde biyoelektriksel impedans analizinin yeri The role of bioelectrical impedance analysis in assessment of fluid volume status in chronic hemodialysis patients Amaç: Kronik hemodiyaliz (HD) tedavisi altındaki hastalarda morbidite ve mortalitenin en önemli sebebi olan kardiyovasküler hastalık ve komplikasyonlarından kaçınmak için, optimal sıvı durumunun elde edilmesi kritik bir önem taşır. Biz çalışmamızda kronik HD hastalarında, biyoelektriksel impedans analizi'nin (BİA) sıvı durumunun değerlendirilmesinde klinik ve ekokardiyografik incelemelere ek bir katkısı olup olmadığını saptamayı amaçladık. Gereç ve Yöntem: Çalışma en az 3 aydır kronik HD tedavisi uygulanmakta olan 46 hasta ile yapıldı. Katılımcıların 0 ve 3. aylarda klinik ve biyokimyasal incelemelerine ek olarak, BİA, nabız dalga hızı (NDH), ekokardiyografik vena kava inferior çapı, 24 saatlik ambulatuvar kan basıncı takibi yapıldı. Bulgular: Hastaların ortalama BİA ile tespit edilen total vücut sıvısı 0. ay ve 3. ayda sırasıyla-0,65±3,30 ve-0,30±1,49 litre olarak tespit edildi. İki ölçümün karşılaştırılması istatistiksel olarak anlamlı bulunmadı (p:.141). Ekokardiyografik vena kava inferior çapları 0. ve 3. ayda sırası ile 13,3±3,02 ve 15,9±3,32 mm olarak bulundu. 3. aydaki vena kava inferior çapının başlangıçtakinden anlamlı olarak geniş olduğu görüldü (p<.005). Başlangıç ve 3. Aydaki Kt/Vüre, hematolojik ve biyokimyasal parametreler, ambulatuvar kan basıncı izlemi verileri ve NDH ölçümleri arasında da istatistiksel anlamlı fark saptanmadı. Sonuç: Çalışma bulgularımız kronik HD hastalarında sıvı volüm durumunun değerlendirilmesinde HD seansı sonrasında yapılan BİA verilerinin klinik bulgulara bir üstünlüğü olmadığını göstermiştir. Bu hasta grubunda sıvı volüm durumunu belirleyecek ideal yöntemin bulunması için daha ileri çalışmalara gereksinim vardır. Anahtar Sözcükler: Arteriyel sertlik; biyoelektriksel impedans; hemodiyaliz; volüm kontrolü. Introduction: In order to avoid cardiovascular disease and its complications, which is the most important cause of morbidity and mortality in patients under chronic hemodialysis (HD), it is critical to obtain optimal fluid status. In this study, we aimed to determine whether bioelectrical impedance analysis (BIA) has an additional contribution to clinical and echocardiographic examinations in the assessment of fluid status in chronic HD patients. Methods: The study was conducted with 46 patients who had been treated with chronic HD for at least 3 months. In addition to clinical and biochemical examinations, BIA, pulse wave velocity (PVW), echocardiographic inferior diameter of the vena cava, and 24-hour ambulatory blood pressure were monitored at 0 and 3 months. Results: The mean total body fluid detected by BIA was 0.65±3.30 and-0.30±1.49 liters at 0 months and 3 months, respectively. Comparison of the two measurements was not statistically significant (p: .141). Echocardiographic diameters of the inferior vena cava were 13.3±3.02 and 15.9±3.32 mm, respectively, at 0 and 3 months. The inferior diameter of the vena cava at 3 months was significantly larger than the initial diameter (p<.005). No statistically significant difference was found between Kt/Vurea, hematological and biochemical parameters, ambulatory blood pressure monitoring data and NDH measurements at baseline and at 3 months. Discussion and Conclusion: Our study findings showed that BIA data obtained after HD session did not have any superiority to clinical findings in the evaluation of fluid volume status in chronic HD patients. Further studies are needed to find the ideal method to determine the fluid volume in this patient group.
New Method to Predict Survival in Hemodialysis Patients Using the Impedance Ratio
Turkish Journal of Nephrology, 2019
Objective: Bioimpedance spectroscopy (BIS) can be used to determine hypervolemia and malnutrition in chronic hemodialysis (HD) patients. In this prospective observational study, we investigated the survival predictability of impedance ratio (IR) calculated by BIS in HD patients (Clinical Trials Gov Identifier: NCT01468363). Materials and Methods: A total of 430 chronic HD patients, out of 500 prevalent chronic HD patients from the city of Zonguldak who met the inclusion criteria, were included in the study. With a mean follow-up of 32.2±14.4 months, BIS was performed in all patients. The IR percentage (IR%) was calculated by dividing the resistance values using the 200 kHz and 5 kHz impulses. Student's t-test, Cox regression analysis, and Kaplan-Meier survival analysis were performed, and a p<0.05 was accepted as statistically significant. Results: The mean age of 430 patients was 59±15 (10-92) years, and 54% of patients were male. By the end of the study, 125 (29%) patients died. Diabetes mellitus was observed in 46% of patients. Sixty-seven percent of patients used erythropoietin, and 41% used diuretics. The mean systolic blood pressure of patients before the dyalisis was 133±26 mmHg, and diastolic blood pressure was 79±12 mmHg. The IR values ranged between 73.2% and 94.1%. A multi-regression analysis that used the IR and included diabetes mellitus, age, gender, and albumin and hemoglobin levels showed that the mortality risk increased 16% (p<0.001). Evaluation using the quartiles showed decreased survival. Survival in the first quartile group was 42.8 months compared to 30.6 months in the last quartile group. Conclusion: The IR calculated using BIS data is a useful tool that can be employed to predict the survival in chronic HD patients. An early awareness of this increased mortality risk is important in terms of a close follow-up and appropriate treatment of these patients.
Journal of Turgut Ozal Medical Center
Aim: Maintaining euvolemia is an important purpose in patients on hemodialysis therapy. Multiple-frequency bioimpedance spectroscopy (BIS) appears to be a useful and appropriate technique for assessing hydration status and body composition in hemodialysis patients.The aims of this study were to determine the pre and post hemodialysis hydration status of the pediatric hemodialysis patients by BIS and compare the dry weight determined by BIS to established by clinically. Material and Methods: Body Composition Monitor (BCM; Fresenius Medical Care, Germany) was performed in 13 pediatric hemodialysis patients in a single center. Patients were measured at the midweek session, once immediately before and once 30 minutes after dialysis. Pre-and post-HD weights, blood pressures, were collected on the day of the BCM measurements. Results: Seven (53.8%) of the 13 patients were male and 6 (46.2%) were female. The mean age ranged from 11.92 ± 3.13 (5.7-16) years and duration time ranged from 7 to 54 months, and the median duration of dialysis was 11 months. Dry weights which was determined clinically were higher than those calculated by BCM. A significant difference was found between mean values (34,71 ± 12,68 versus 33,71 ± 12,16 kg, Δ: 1 ± 1,51, p = 0.035). There was a high positive correlation between dry weights measured by BCM and dry weight established by nephrologists (r = 0.993, p <0.001). Conclusion: In assessing dry weight, BCM appears to be a quick and easy-to-use tool that can assist the clinician in hemodialysis treatment and optimizing patient outcomes.
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 2018
In the absence of a gold standard technique for assessing nutrition status in patients receiving hemodialysis (HD), we aimed to determine the diagnostic accuracy of single-frequency (50 kHz) bioelectrical impedance analysis parameters, resistance/height (R/H), reactance/height (Xc/H), and impedance/height (Z/H), and their cutoff points for malnutrition. The reference standards, Subjective Global Assessment (SGA), Malnutrition Inflammation Score, and Nutritional Risk Screening 2002, were performed at baseline and then once a year for 2 years. At least 2 assessments for each reference standard were performed during the monitoring period, and those patients who were assessed as malnourished on at least 2 consecutive occasions were classified as malnourished. A total 101 patients receiving HD were evaluated. R/H and Z/H demonstrated low to moderate accuracy to diagnose malnutrition in men and low accuracy in women, whereas the accuracy of Xc/H was uncertain. The cutoff points of bioelec...
International Urology and Nephrology, 2014
Purpose The present study was designed to determine the cutoff points for the diagnosis of mild-to-moderate and severe protein-energy wasting (PEW) based on dialysis malnutrition score (DMS) and malnutrition inflammation score (MIS), and the sensitivity, specificity, accuracy, area under receiver operating characteristic (ROC) curve, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR ? ) and negative likelihood ratio (LR -) of DMS and MIS in comparison with subjective global assessment (SGA) in hemodialysis (HD) patients.
Journal of Physics: …, 2012
The accuracy of BIA measurements is limited by different sources of error such as physical model, cross sectional area, ethnicity, body hydration, age and level of body fat among other variables. Equation for each population is required as they can produce overestimation when manufacturer's equations are used. The classical measurements hand to foot has shown better correlation against hydrodensitometry than foot to foot or hand to hand. However there is a lack for an accepted standard of BIA procedures. This is compounded when there is not a good report of the BIA study's methodology; hence the comparability between the results is poor and reduces the reliability of the method. Perhaps, standardization of methods would be the first step for BIA studies to move forward and subsequently improve its accuracy. Standardized procedures could also minimize the impact of these variables on studies results. The aim of this study was to propose a protocol as a checklist to standardize BIA procedures and produce comparable results from future studies performed with the classic hand-foot configuration in adults. If BIA is to gain reliability in clinical assessment and monitoring treatments, further efforts will be needed to develop, implement and report universal protocols [5, 8]. Therefore, this study aimed to propose a protocol as a checklist for future users of classical hand to foot BIA. 2. Methods We collected information available from the scientific literature where variables affecting BIA results were reported. Afterwards, these variables were categorized according to their source, and a list in keeping with their impact on BIA results was made. Finally a checklist for standardized BIA procedures was developed which would be useful for future studies.
Journal of Nutrition and Metabolism
Background. Body composition measurement is very important for early nutritional care in hemodialysis patients. Dual-energy X-ray absorptiometry (DXA) is a gold standard test, but clinically limited. Bioelectrical impedance analysis (BIA) with multifrequency technique is a practical and reliable tool. Objective. This cross-sectional study was aimed to compare the agreement of BIA with DXA in measurement of body composition in hemodialysis patients and to evaluate their associated factors. Methods. Body composition was measured by 2 BIA methods (InBody S10 and InBody 720) and DXA after a hemodialysis session. A total of 69 measurements were included. Pearson’s correlation and Bland and Altman analysis were used to determine the correlation of body composition between methods and to compare the methods agreement, respectively. Results. The correlation coefficients of body compositions were strong between DXA and InBody S10 (fat mass index (FMI): r=0.95, fat-free mass index (FFMI): r=0...
Background. Maintenance of the optimal fluid status in hemodialysis patients is still a challenging task in daily clinical practice. A bioelectric impedance technique has been applied for evaluation of hydration status in the dialysis population in recent years, but serial observations of its role in clinical dry weight determination are lacking. In this study, serial follow-up data of a body composition monitor based on bioimpedance spectroscopy (BCM-BIS) applied in dialysis patients were analyzed to define the technique's feasibility, precision and possible role in dry weight determination. Methods. BCM-BIS was applied monthly to 194 hemodialysis patients for 6 months. Intra-patient precision was analyzed. Bland-Altman analysis and repeated-measures analysis of variance (ANOVA) were used to define the relationship between the dry weights determined by BCM-BIS and by clinical judgment. Results. The coefficients of variation (CVs) of fluid parameters were <5%. Serial changes in dry weight differences were compared in groups with different post-dialysis hydration status and dry weight differences decreased gradually. Bland-Altman analysis revealed that the range of these differences was significantly narrower towards the latter part of the study. The upper limit of agreement with 95% confidence interval (CI) was 1.47 L and the lower limit was −3.02 L. Conclusions. BCM-BIS is precise and can be easily applied in the clinical setting. Discrepancy between the dry weights determined by BCM-BIS and by clinical judgment significantly decreased during the study. It is sensitive in dry weight determination, especially for those patients with obvious over-hydration (OH) by BCM-BIS. Patients with post-dialysis OH results beyond some critical values (>1.5 L or <−3 L) should be closely monitored.