Bioimpedanciometry in nutritional and hydration assessments in a single dialysis center

Abstract

Background: Bioimpedance analysis (BIA) has been demonstrated to add accuracy to nutritional and volume status assessments in dialysis (HD) patients. Aim: to describe a sample of dialysis patients from a single center on their demographics and BIA of volume distribution and nutritional status, and mortality during 12-month follow-up. Methods: prospective observational cohort study to evaluate vintage HD patients with single-frequency BIA. Results: we evaluated 82 patients, 29% over 65 years old. Elderly patients had higher ECW/TBW (0.51 vs. 0.44, p < 0.0001), and narrower phase angle (PhA) (4.9 vs. 6.4º, p < 0.0001). Fifteen patients (18.2%) died during follow-up, eight (53%) were elderly. Death was associated with age (62.6 vs. 50.2 years, p = 0.012), post-HD PhA (4.8 vs. 6.2º, p = 0.0001), and post-HD ECW/TBW (0.50 vs. 0.45, p = 0.015). The ROC curve analysis to predict mortality found ECW/TBW ≥ 0.47 and PhA ≤ 5.5º to have the best sensitivity and specificity. One-year patient survival was lower with post-HD ECW/TBW ≥ 0.47 (69.5% vs. 90.6%, p = 0.019), age ≥ 65 years (64.2%, vs. 86.2%, p = 0.029), and PhA ≤ 5.5º (68.2 vs. 91.0%, p = 0.002). Cox regression analysis demonstrated that PhA [HR 5.04 (95%CI 1.60–15.86), p = 0.006] remained associated with death after adjusting for age and ECW/TBW. Conclusion: BIA is useful in assessing volume distribution and nutrition in HD patients, and combined with clinical judgement, may help determine dry weight, especially in elderly patients. Narrower PhA and higher ECW/TBW after HD were associated with poorer one-year survival.

The value of bioimpedance analysis in the assessment of hydration and nutritional status in children on chronic peritoneal dialysis

“…BIA-BCM was performed twice on the same day after admission (Patients with regular peritoneal dialysis are hospitalized every 3-6 months for a comprehensive assessment of peritoneal dialysis adequacy and complications of CKD in our center), and the mean value of the two measurements was taken. The same physician performed both BIA-BCM measurements using a portable BIA-BCM device (Fresenius Medical Care, Bad Homburg, Germany) [ 12 ]. Each child was placed in a semirecumbent position, and BIA-BCM electrode patches were attached to the arms.…”

“…This method is highly consistent with the gold-standard dilution method [ 10 ] and shows promise as a method to evaluate body composition in pediatrics [ 11 ]. The BIA-BCM device (Fresenius Medical Care, Bad Homburg, Germany) is a physiological tissue model based on this principle [ 12 ].…”

Finding meaning in bioimpedance for people treated with hemodialysis

“…In this issue, Zeni et al 1 report a prospective, observational study evaluating bioimpedance for nutritional and volume status assessment in a single-center cohort in Brazil. The study clearly demonstrates the issues raised above.…”

Encontrando significado na bioimpedância para pessoas em tratamento com hemodiálise

“…Nesta edição, Zeni et al 1 relatam um estudo observacional prospectivo que avalia a bioimpedância para avaliação do estado nutricional e volêmico em uma coorte de centro único no Brasil. O estudo demonstra claramente as questões levantadas acima.…”