Bioimpedance Indices of Fluid Overload and Cardiorenal Outcomes in Heart Failure and Chronic Kidney Disease: a Systematic Review

Mayne, Kaitlin J.; Shemilt, Richard; Keane, David; Lees, Jennifer; Mark, Patrick B.; Herrington, William G.

doi:10.1016/j.cardfail.2022.08.005

Cited by 16 publications

(25 citation statements)

References 95 publications

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“…Whole body bioimpedance parameters of fluid overload appear to be consistently and positively correlated with increased risk of death and adverse cardiovascular outcomes (Mayne et al, 2022 ). Liu et al reported that every increment increase in ECW (%TBW) by 0.001 was associated with an increased risk of a heart failure‐related event (hospitalization or death) by 6% (HR 1.06, 95% CI 1.02–1.10) in patients with CKD (Liu et al, 2012 ).…”

Section: Discussionmentioning

confidence: 99%

Sex differences in body fluid composition in humans with obstructive sleep apnea before and after CPAP therapy

Nicholl

Hanly

MacRae

et al. 2023

Physiological Reports

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Obstructive sleep apnea (OSA) is common in heart and kidney disease, both conditions prone to fluid retention. Nocturnal rostral fluid shift contributes to the pathogenesis of OSA in men more than women, suggesting a potential role for sex differences in body fluid composition in the pathogenesis of OSA, with men having a predisposition to more severe OSA due to an underlying volume expanded state. Continuous positive airway pressure (CPAP) increases intraluminal pressure in the upper airway and mitigates the rostral fluid shift; this, in turn, may prevent fluid redistribution from other parts of the body to the upper airway. We sought to determine the impact of CPAP on sex differences in body fluid composition. Twenty‐nine (10 women, 19 men) incident, sodium replete, otherwise healthy participants who were referred with symptomatic OSA (oxygen desaturation index >15/h) were studied pre‐ and post‐CPAP (>4 h/night × 4 weeks) using bioimpedance analysis. Bioimpedance parameters including fat‐free mass (FFM, %body mass), total body water (TBW, %FFM), extracellular and intracellular water (ECW and ICW, %TBW), and phase angle (°) were measured and evaluated for sex differences before and after CPAP. Pre‐CPAP, despite TBW being similar between sexes (74.6 ± 0.4 vs. 74.3 ± 0.2%FFM, p = 0.14; all values women vs. men), ECW (49.7 ± 0.7 vs. 44.0 ± 0.9%TBW, p < 0.001) was increased, while ICW (49.7 ± 0.5 vs. 55.8 ± 0.9%TBW, p < 0.001) and phase angle (6.7 ± 0.3 vs. 8.0 ± 0.3°, p = 0.005) were reduced in women compared to men. There were no sex differences in response to CPAP (∆TBW –1.0 ± 0.8 vs. 0.7 ± 0.7%FFM, p = 0.14; ∆ECW –0.1 ± 0.8 vs. −0.3 ± 1.0%TBW, p = 0.3; ∆ICW 0.7 ± 0.4 vs. 0.5 ± 1.0%TBW, p = 0.2; ∆Phase Angle 0.2 ± 0.3 vs. 0.0 ± 0.1°, p = 0.7). Women with OSA had baseline parameters favoring volume expansion (increased ECW, reduced phase angle) compared to men. Changes in body fluid composition parameters in response to CPAP did not differ by sex.

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Section: Discussionmentioning

confidence: 99%

Sex differences in body fluid composition in humans with obstructive sleep apnea before and after CPAP therapy

Nicholl

Hanly

MacRae

et al. 2023

Physiological Reports

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“…1A). Systematic reviews have been published on cancer [5,[7][8][9][10], sarcopenia [11], surgery [12], critical illness [13], heart failure and chronic kidney disease [14], obesity [15], metabolic diseases [16], coronavirus disease-2019 (COVID-19) [17] and in different diseases states [18]. Systematic reviews and meta-analysis to estimate mean PhA values in healthy individuals [19], critical illness [20], and cardiovascular diseases [21].…”

Section: Overview Of the Value Of Pha In Biomedical Researchmentioning

confidence: 99%

Future lines of research on phase angle: Strengths and limitations

Guerrero

García-García

Talluri³

et al. 2023

Rev Endocr Metab Disord

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Bioelectrical impedance analysis (BIA) is the most widely used technique in body composition analysis. When we focus the use of phase sensitive BIA on its raw parameters Resistance (R), Reactance (Xc) and Phase Angle (PhA), we eliminate the bias of using predictive equations based on reference models. In particular PhA, have demonstrated their prognostic utility in multiple aspects of health and disease. In recent years, as a strong association between prognostic and diagnostic factors has been observed, scientific interest in the utility of PhA has increased. In the different fields of knowledge in biomedical research, there are different ways of assessing the impact of a scientific-technical aspect such as PhA. Single frequency with phase detection bioimpedance analysis (SF-BIA) using a 50 kHz single frequency device and tetrapolar wrist-ankle electrode placement is the most widely used bioimpedance approach for characterization of whole-body composition. However, the incorporation of vector representation of raw bioelectrical parameters and direct mathematical calculations without the need for regression equations for the analysis of body compartments has been one of the most important aspects for the development of research in this area. These results provide new evidence for the validity of phase-sensitive bioelectrical measurements as biomarkers of fluid and nutritional status. To enable the development of clinical research that provides consistent results, it is essential to establish appropriate standardization of PhA measurement techniques. Standardization of test protocols will facilitate the diagnosis and assessment of the risk associated with reduced PhA and the evaluation of changes in response to therapeutic interventions. In this paper, we describe and overview the value of PhA in biomedical research, technical and instrumental aspects of PhA research, analysis of Areas of clinical research (cancer patients, digestive and liver diseases, critical and surgical patients, Respiratory, infectious, and COVID-19, obesity and metabolic diseases, Heart and kidney failure, Malnutrition and sarcopenia), characterisation of the different research outcomes, Morphofunctional assessment in disease-related malnutrition and other metabolic disorders: validation of PhA with reference clinical practice techniques, strengths and limitations. Based on the detailed study of the measurement technique, some of the key issues to be considered in future PhA research. On the other hand, it is important to assess the clinical conditions and the phenotype of the patients, as well as to establish a disease-specific clinical profile. The appropriate selection of the most critical outcomes is another fundamental aspect of research.

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“…These have focused on moderate fluid overload (>1.1 L or >7%) as an exposure since severe fluid overload is relatively uncommon before kidney failure develops. In a recent systematic review we identified 11 CKD without KRT cohorts reporting associations between bioimpedance indices of fluid overload and mortality, cardiovascular outcomes and/or CKD progression [ 9 ]. There is consistent evidence of positive associations between moderate fluid overload with these adverse cardiorenal outcomes [ 9 ].…”

Section: Bioimpedance In Ckd Without Kidney Replacement Therapy (Krt)mentioning

confidence: 99%

“…In a recent systematic review we identified 11 CKD without KRT cohorts reporting associations between bioimpedance indices of fluid overload and mortality, cardiovascular outcomes and/or CKD progression [ 9 ]. There is consistent evidence of positive associations between moderate fluid overload with these adverse cardiorenal outcomes [ 9 ]. Formal observational meta-analysis was not possible due to substantial variation in bioimpedance methods and fluid overload definitions.…”

Section: Bioimpedance In Ckd Without Kidney Replacement Therapy (Krt)mentioning

confidence: 99%

“…Another feature of the current published literature using bioimpedance in CKD without KRT is a lack of phenotyping for coexistent heart failure, with bioimpedance studies in heart failure cohorts also often overlooking the consideration of kidney parameters [ 9 ]. In early CKD, even 1 L excess ECW measured by BIS has been associated with the development of left ventricular hypertrophy and diastolic dysfunction [ 10 ].…”

Section: Bioimpedance In Ckd Without Kidney Replacement Therapy (Krt)mentioning

confidence: 99%

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Bioimpedance in CKD: an untapped resource?

Mayne

Lees

Herrington

2022

Nephrology Dialysis Transplantation

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Bioimpedance devices estimate body water and fat by measuring opposition to an electrical current applied via the skin. The most commonly reported device from existing dialysis literature is the Fresenius Body Composition Monitor (BCM), which uses bioimpedance spectroscopy (BIS). Although sometimes used interchangeably, BIS is not synonymous with bioimpedance analysis (BIA). BIA traditionally used only a single frequency before multifrequency BIA devices were developed, which measure impedance at 50-200 discrete frequencies from 3 to 1000 kHz. BIS extends this range by extrapolation to zero and infinity kHz. Greater frequency range improves discrimination of extracellular (ECW) from intracellular water. All BIS/BIA devices also estimate lean and fat tissue, but the BCM uniquely specifically quantifies fluid overload independent of body composition using the threecompartment model [1].

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Bioimpedance Indices of Fluid Overload and Cardiorenal Outcomes in Heart Failure and Chronic Kidney Disease: a Systematic Review

Cited by 16 publications

References 95 publications

Sex differences in body fluid composition in humans with obstructive sleep apnea before and after CPAP therapy

Sex differences in body fluid composition in humans with obstructive sleep apnea before and after CPAP therapy

Future lines of research on phase angle: Strengths and limitations

Bioimpedance in CKD: an untapped resource?

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