Measuring body composition in chronic heart failure: A comparison of methods

Abstract

Aims: Fat-free mass (FFM) is increasingly recognized as a systemic marker of disease severity in chronic organ failure and is an important target for physiologic and pharmacologic interventions to improve functional status. The aim of this study was therefore to evaluate two clinical methods to assess FFM in patients with chronic heart failure (CHF) using deuterium dilution (DEU) as reference and bromide dilution to assess the ratio between intracellular (ICW) and extracellular water (ECW) as potential confounder. Methods: Body composition was measured with dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA) and DEU in 22 stable patients from our heart failure outpatient clinic and 24 healthy age matched controls. Results: FFM values measured by DXA and DEU in patients (r = 0.92, SEE: 3.1 kg) and controls (r = 0.99, SEE: 1.3 kg) were strongly related. In both patients and controls, the inter method difference increased with higher values of FFM (DXA overestimating DEU). The ICW / ECW ratio was within the normal range and comparable between the groups. In patients, a highly significant correlation coefficient was found (r = 0.93, SEE 2.1 p = 0.01) between total body water (DEU) and height squared/resistance (Ht 2 / R). On multiple regression next to Ht 2 / R, body weight was an independent predictor of FFM DEU (r = 0.95, SEE 2.5 kg, p < 0.001; TBWdeu = 0.528 Ht 2 / R + (0.182 weight) + 8.277). Conclusion: DXA and DEU are appropriate and interchangeable laboratory methods for assessment of FFM in clinically stable heart failure patients, however, overestimation of FFM DXA should be considered. BIA is a suitable clinical alternative for diagnostic purposes.

What Is the Upper Limitation of Volume in Chinese Peritoneal Dialysis Patients?

“…Hypertension is a major risk factor for adverse cardiovascular events and is endemic in end-stage renal disease patients [36]. Although the pathophysiology of hypertension in dialysis patients is multifactorial, many studies in recent years have suggested that volume overload may be the most important etiology [37,38,39,40]. In one study by Gunal et al [41], hypertension was completely normalized through strict fluid volume control.…”

Fluid Overload

“…However, charted daily fluid balance do seem to be a more useful guide in determining the risk of fluid overload than daily weights in the ICU, which can be inaccurate in guiding fluid management in the critical care setting. 108 Bioelectrical impedance bodycomposition analysis (BIA), a noninvasive method of fluid assessment, can provide estimates of total-body, extracellular, and intracellular water to allow the quantification of fluid overload and setting of dry weight 109,110 ; BIA is used widely in determining the fluid status in patients with end-stage renal failure on hemodialysis or peritoneal dialysis. However, this technology has not been extensively validated in critical care; its benefit over use of a well-kept fluid balance has not yet been established.…”

Fluid management in acute kidney injury

“…However charted daily fluid balance does appear to be a more useful guide in determining risk of fluid overload than daily weight, which can be inaccurate in the critical care setting [69]. However even the most accurate fluid balance will fail to account for uncertain fluid status at ICU admission.…”