Three compartment bioimpedance spectroscopy in the nutritional assessment and the outcome of patients with advanced or end stage kidney disease: What have we learned so far?

Abstract

Bioimpedance spectroscopy (BIS) is an easily applicable tool to assess body composition. The three compartment model BIS (3C BIS) conventionally expresses body composition as lean tissue index (LTI) (lean tissue mass [LTM]/height in meters squared) and fat tissue index (FTI) (adipose tissue mass/ height in meters squared), and a virtual compartment reflecting fluid overload (FO). It has been studied extensively in relation to diagnosis and treatment guidance of fluid status disorders in patients with advanced-stage or end-stage renal disease. It is the aim of this article to provide a narrative review on the relevance of 3C BIS in the nutritional assessment in this population. At a population level, LTI decreases after the start of hemodialysis, whereas FTI increases. LTI below the 10th percentile is a consistent predictor of outcome whereas a low FTI is predominantly associated with outcome when combined with a low LTI. Recent research also showed the connection between low LTI, inflammation, and FO, which are cumulatively associated with an increased mortality risk. However, studies toward nutritional interventions based on BIS data are still lacking in this population. In conclusion, 3C BIS, by disentangling the components of body mass index, has contributed to our understanding of the relevance of abnormalities in different body compartments in chronic kidney disease patients, and appears to be a valuable prognostic tool, at least at a population level. Studies assessing the effect of BIS guided nutritional intervention could further support its use in the daily clinical care for renal patients.

Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis

“…BIA, a noninvasive rapid and reliable method with low cost, is also commonly used to evaluate body composition for both epidemiological and clinical purposes [38]. A principle of BIA techniques is that the transit time of a low-voltage electric current through the body is dependent on body composition characteristics [39].…”

Quantitative assessment of sodium mass removal using ionic dialysance and sodium gradient as a proxy tool: Comparison of high‐flux hemodialysis versus online hemodiafiltration

“…[42][43][44] In our study, we have used a validated multifrequency bioimpedance spectroscopy device (Body Composition Monitor) to assess true total body water and relative fluid overload in dialysis patients from which we estimated extracellular fluid volume as one third of the total body water. [45][46][47] Body composition was measured in all patients before the dialysis session and weight lost during dialysis (fluid removed) was deduced from predialysis total body water content to obtain patient's isovolemic total body water status. 48,49 Various approaches were used to calculate total body water in our dialysis population including the Watson formula but also a Kt/V-based formula derived from urea kinetic and ionic dialysance.…”

Body composition monitoring in children and adolescents: reproducibility and reference values

“…Initially, the application of the device focused on the evaluation of the fluid status in end-stage renal disease patients. Nevertheless, over the past few years, the BCM is increasingly being used for nutritional assessment as well [11,12]. The BCM model has shown potential in various populations in paediatrics, but several barriers still need to be overcome to allow a widespread application of the device in both research and clinical practices.…”