Assessment of Fluid and Nutritional Status Using Multifrequency Bioelectrical Impedance Analysis in Peritoneal Dialysis Patients

Hyun, Seung-Hyea; Choi, Jiyoung; Cho, Jang‐Hee; Park, Sun-Hee; Kim, Chan‐Duck; Kim, Yong-Lim

doi:10.1159/000360272

Cited by 13 publications

(12 citation statements)

References 24 publications

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“… 14 Due to the association between PhA and most nutritional markers, it has a prognostic usefulness in HD patients. BCM is an another representative parameter of nutritional status 8 that appears to be less influenced by variation in blood volume. Therefore it is a useful parameter for assessing the nutritional status in dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of hydration and nutritional status between young and elderly hemodialysis patients through bioimpedance analysis

Lee¹,

Jo²,

Lee³

et al. 2015

CIA

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BackgroundThe number of elderly people on dialysis is increasing rapidly. Fluid overload and malnutrition status are serious problems in elderly dialysis patients. We aimed to compare the hydration and nutritional status through bioimpedance analysis (BIA) between young and elderly hemodialysis (HD) patients and to analyze risk factors related to fluid overload and malnutrition status in these patients.MethodWe conducted a cross-sectional study, in which 82 HD (males 42, mean age 58.7±12.9 years) patients were enrolled. We collected different types of data: laboratory data, such as serum creatinine, albumin, total iron-binding capacity, hemoglobin, total cholesterol; anthropometric data, such as hand grip strength (HGS); BIA data, such as intracellular water, skeletal muscle mass, body cell mass, bone mineral content, phase angle (PhA), extra cellular water (ECW)/total body water (TBW) ratio; and malnutrition-inflammation score (MIS), which is a traditional nutritional parameter for dialysis patients. All patients were stratified into two groups according to their age: young (<65 years [n=54]) and elderly (≥65 years [n=28]).ResultsTotal iron-binding capacity and HGS were significantly lower in elderly HD patients than in young HD patients (198.9±35.6 vs 221.4±52.1 mcg/dL; and 22.4±10.3 vs 36.4±23.2 kg, respectively) (P<0.05). Also, intracellular water and PhA measured by BIA were significantly lower (18.3±4.0 vs 20.3±4.2 L [P=0.043]; and 4.0±1.0 vs 4.9±1.2° [P=0.002], respectively), and ECW/TBW were higher in elderly HD patients (0.40±0.01 vs 0.39±0.01 [P=0.001]). ECW/TBW was positively associated with age (P<0.001) and the presence of diabetes (P<0.001) and was negatively associated with sex (P=0.001), albumin (P<0.001), urine volume (P=0.042), HGS (P<0.001), and PhA by BIA (P<0.001). MIS was negatively related to sex (P=0.001), albumin (P<0.001), HGS (P=0.001), and PhA (P<0.001) in HD patients. On multivariate analysis, older age (P=0.031), the presence of diabetes (P=0.035), and decreased PhA (P<0.001) were independent risk factors for increased ECW/TBW, representative of fluid overload status, whereas only decreased PhA (P=0.008) was a significant factor for MIS, representative of malnutrition status in these HD patients.ConclusionWe found that fluid overload and malnutrition status were more common in elderly HD patients compared with young HD patients. PhA was a significant independent factor in fluid overload status and malnutrition in these HD patients. Thus, our results indicated that PhA assessed by BIA might be a clinically useful method for assessing nutritional and hydration status in elderly HD patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of hydration and nutritional status between young and elderly hemodialysis patients through bioimpedance analysis

Lee¹,

Jo²,

Lee³

et al. 2015

CIA

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“…When considering risk factors for mortality and dialysis inadequacy among PD patients, recent focus has shifted from small-molecule clearance to fluid overload [9]. Fluid overload is considered a contributor to mortality and technique failure among PD patients due to its association with complications such as hypertension [10], heart failure [11], increased cardiovascular event [12], arterial stiffness [13] and peritonitis [14], as well as inflammation [15], malnutrition [15,16] and loss of residual renal function [17,18]. However, it remains unclear whether overhydration is an independent predictor of PD clinical outcomes or whether it just reflects underlying comorbidities such as hypertension and cardiac dysfunction.…”

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confidence: 99%

The Effect of Overhydration on Mortality and Technique Failure Among Peritoneal Dialysis Patients: A Systematic Review and Meta-Analysis

et al. 2018

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Background: Overhydration is common among peritoneal dialysis (PD) patients and can affect PD-related outcomes. This paper aims to systematically investigate whether bioimpedance-assessed overhydration is a predictor for mortality and technique failure in PD patients. Methods: We conducted a systematic review and meta-analysis of cohort studies on overhydration and prognosis in PD patients, strictly complying with the Preferred Reporting Items for Systematical Reviews and Meta-analyses. Results: Eight articles met the selection criteria and 5 studies were included in the meta-analysis. Meta-analyses-revealed overhydration, defined as a high ratio of extracellular water/total body water (ECW/TBW), was significantly associated with higher risk for all-cause mortality and technique failure. Other higher dichotomized overhydration indicators and continuous hydration variables all indicated overhydration as a significant risk factor for all-cause mortality. Conclusion: Overhydration, defined by a higher ratio of ECW/TBW, might be an independent predictor for all-cause mortality and technique failure among PD patients. However, more studies are needed to confirm this conclusion. Video Journal Club ‘Cappuccino with Claudio Ronco’ at https://www.karger.com/Journal/ArticleNews/223997?sponsor=52

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“…Additionally, O’Lone et al recently reported the clinical significance of the OH index, - an accurate value of overhydration that was an independent predictor of mortality in contrast to the ECW/total body water (TBW) [ 22 ]. Different BIS parameters, such as ECW/TBW, ECW normalized for height, the OH value, and tissue hydration, have been used as indices of hydration in previous studies [ 6 , 9 , 10 ]. In other words, there is no definite BIS parameter for assessing the hydration status.…”

Section: Discussionmentioning

confidence: 99%

“…Bioimpedance spectroscopy (BIS) has been used to measure the water compartment of the body [ 6 ]. In patients on dialysis, body composition, including extracellular water (ECW) and intracellular water (ICW), muscle mass, and fat mass, changes slowly over several months.…”

Section: Introductionmentioning

confidence: 99%

Control of fluid balance guided by body composition monitoring in patients on peritoneal dialysis (COMPASS): study protocol for a randomized controlled trial

Baek

Kim

et al. 2014

Trials

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BackgroundThe clinical benefits of bioimpedance spectroscopy (BIS)-guided fluid management in patients on hemodialysis have been widely demonstrated. However, no previous reports have evaluated the effect of regular and serial BIS-guided fluid management on the residual renal function (RRF) in patients on peritoneal dialysis (PD). Therefore, we will evaluate the clinical efficacy of BIS-guided fluid management for preserving RRF and protecting cardiovascular events in patients on PD.Methods/designThis is a multicenter, prospective, randomized controlled trial. A total of 138 participants on PD will be enrolled and randomly assigned to receive either BIS-guided fluid management or fluid management based only on the clinical information for 1 year. The primary outcome is the change in the glomerular filtration rate (GFR) between months 0 and 12 after starting treatment. The secondary outcomes will include GFR at month 12, time to the anuric state (urine volume <100 ml/day), and fatal and nonfatal cardiovascular events during treatment.DiscussionThis is the first clinical trial to investigate the effect of BIS-guided fluid management on RRF and for protecting against cardiovascular events in patients on PD.Trial registrationClinical Trials.gov number NCT01887262, June 24, 2013.

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Assessment of Fluid and Nutritional Status Using Multifrequency Bioelectrical Impedance Analysis in Peritoneal Dialysis Patients

Cited by 13 publications

References 24 publications

Comparison of hydration and nutritional status between young and elderly hemodialysis patients through bioimpedance analysis

Comparison of hydration and nutritional status between young and elderly hemodialysis patients through bioimpedance analysis

The Effect of Overhydration on Mortality and Technique Failure Among Peritoneal Dialysis Patients: A Systematic Review and Meta-Analysis

Control of fluid balance guided by body composition monitoring in patients on peritoneal dialysis (COMPASS): study protocol for a randomized controlled trial

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