Bioimpedance for assessing volume status in children with nephrotic syndrome

Özdemir, Kadriye; Mir, Makbule Sevgi; Dinçel, Nida; Bozabali, Sibel; Bulut, İpek Kaplan; Sözeri, Betül

doi:10.3906/sag-1312-132

Cited by 14 publications

(13 citation statements)

References 25 publications

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“…In the present study, BIS clearly indicated a higher ECW in the ANS patients compared to both the controls (HC group) and patients at remission (NSR group). Importantly, these findings accord with observations made in previous studies in NS patients [4, 25], where absolute fluid volumes were estimated using predictive methods.…”

Section: Discussionsupporting

confidence: 91%

Bioimpedance Resistance Indices and Cell Membrane Capacitance Used to Assess Disease Status and Cell Membrane Integrity in Children with Nephrotic Syndrome

Brantlov

Jødal

Andersen

et al. 2019

The Scientific World Journal

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Background. Accumulation of extracellular water (ECW) is a major clinical manifestation of nephrotic syndrome (NS) in children. Bioimpedance spectroscopy (BIS) is a simple, noninvasive technique that reflects body water volumes. BIS can further measure cell membrane capacitance (CM), which may be altered in NS. The aims of the study were to explore how BIS measurements could reflect disease status in NS, while avoiding prediction equations which are often only validated in adult populations. Methods. The study involved 8 children (2-10 years) with active NS (ANS group), 5 of which were also studied at NS remission (NSR group), as well as 38 healthy children of similar age (HC group). BIS measurements determined resistances RINF, RE, and RI (reflecting total body water, extracellular water, and intracellular water) and CM. Also resistance indices based on height (H) were considered, RI = H2/R. Results. It was found that RE and RINF were significantly lower in the ANS group than in both NSR and HC groups (p < 0.001). Corresponding resistance indices were significantly higher in the ANS group than in the NSR (p < 0.01) and the HC (p < 0.05) groups, in accordance with elevated water volumes in NS patients. Indices of intracellular water were not significantly different between groups. CM was significantly lower in the ANS group than in NSR and HC groups (p < 0.05). Conclusion. BIS could distinguish children with active NS from well-treated and healthy children. Studies with more children are warranted.

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Section: Discussionsupporting

confidence: 91%

Bioimpedance Resistance Indices and Cell Membrane Capacitance Used to Assess Disease Status and Cell Membrane Integrity in Children with Nephrotic Syndrome

Brantlov

Jødal

Andersen

et al. 2019

The Scientific World Journal

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“…However, data regarding the usage of bioelectrical impedance in nephrotic syndrome is limited. So far, bioimpedance technology has been used to estimate the fluid status of patients with nephrotic syndrome rather than body composition [18][19][20][21]. We decided to use this method to compare body composition in different groups of patients with kidney disease as simple tool which can be used at the patients' bedside.…”

Section: Discussionmentioning

confidence: 99%

Protein energy-wasting associated with nephrotic syndrome – the comparison of metabolic pattern in severe nephrosis to different stages of chronic kidney disease

et al. 2020

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Background: Nephrotic syndrome (NS) is associated with a hypercatabolic state expressed as an exacerbated degradation of muscle mass. However, the clinical significance of this phenomenon has not yet been investigated. The aim of the study was to evaluate the nutritional status of patients with severe NS (defined as nephrotic range proteinuria with hypoalbuminemia ≤2.5 g/dL) and estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m 2 in comparison to patients in different stages of chronic kidney disease (CKD). Methods: Twenty men with severe NS (NS group) and 40 men without proteinuria similar in term of serum creatinine (control group) were included into the study. A retrospective cohort of 40 men with CKD stage G4 (PreD group) and 20 haemodialysis men (HD group) were added to the analysis after matching for age, height and weight using propensity score matching. The bioimpedance spectroscopy and biochemical nutritional markers were evaluated. Results: Nephrotic patients had a significantly lower lean tissue mass (LTM; p = 0.035) and index (a quotient of LTM over height squared, LTI; p = 0.068), with an expected deficiency of LTM by 3.2 kg, and LTI by 0.9 kg/m 2 when compared to the control group. A significant lean tissue deficit (defined as LTI below the lower limit of the reference range by 1.0 kg/m 2) was observed in 12.5% of patients in the control group in comparison to 31.7% with advanced CKD (PreD+HD; p = 0.032) and 50% with NS (p = 0.003). NS group presented with higher phosphorus (p = 0.029), uric acid (p = 0.002) and blood urea (p = 0.049) than the control group. Blood urea was strongly negatively correlated with LTM in NS (r = − 0.64, p = 0.002). Nine nephrotic patients (45%) were identified as hypercatabolic based on severe hyperphosphatemia (> 5.0 mg/dL) and/or hyperuricemia (> 8.0 mg/dL), and were characterized by higher blood urea and lower prealbumin, as well as LTM lower by 5.6 kg than in less catabolic individuals. Conclusions: In term of lean tissue amount, NS group was more similar to advanced CKD than to the control group. We concluded that specific metabolic pattern with elevated phosphorus, uric acid and blood urea, and lean tissue deficiency may be defined as protein-energy wasting associated with nephrotic syndrome (neph-PEW).

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“…The repeated measurements showed superior reproducibility of BCM-derived TBW estimates as compared to UKM-derived values, which is not surprising considering the simplicity of bioimpedance measurements as compared to the substantial biological and technical variation associated with a methodology requiring repeated blood sampling and laboratory measurements. The advantage of simplicity was also emphasised in a recent study comparing fluid status in children with nephrotic syndrome by bioimpedance and echocardiography [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Validating the use of bioimpedance spectroscopy for assessment of fluid status in children

et al. 2018

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BackgroundBioimpedance spectroscopy (BIS) with a whole-body model to distinguish excess fluid from major body tissue hydration can provide objective assessment of fluid status. BIS is integrated into the Body Composition Monitor (BCM) and is validated in adults, but not children. This study aimed to (1) assess agreement between BCM-measured total body water (TBW) and a gold standard technique in healthy children, (2) compare TBW_BCM with TBW from Urea Kinetic Modelling (UKM) in haemodialysis children and (3) investigate systematic deviation from zero in measured excess fluid in healthy children across paediatric age range.MethodsTBW_BCM and excess fluid was determined from standard wrist-to-ankle BCM measurement. TBW_D2O was determined from deuterium concentration decline in serial urine samples over 5 days in healthy children. UKM was used to measure body water in children receiving haemodialysis. Agreement between methods was analysed using paired t test and Bland-Altman method comparison.ResultsIn 61 healthy children (6–14 years, 32 male), mean TBW_BCM and TBW_D2O were 21.1 ± 5.6 and 20.5 ± 5.8 L respectively. There was good agreement between TBW_BCM and TBW_D2O (R2 = 0.97). In six haemodialysis children (4–13 years, 4 male), 45 concomitant measurements over 8 months showed good TBW_BCM and TBW_UKM agreement (mean difference − 0.4 L, 2SD = ± 3.0 L). In 634 healthy children (2–17 years, 300 male), BCM-measured overhydration was − 0.1 ± 0.7 L (10–90th percentile − 0.8 to + 0.6 L). There was no correlation between age and OH (p = 0.28).ConclusionsThese results suggest BCM can be used in children as young as 2 years to measure normally hydrated weight and assess fluid status.Electronic supplementary materialThe online version of this article (10.1007/s00467-018-3971-x) contains supplementary material, which is available to authorized users.

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Bioimpedance for assessing volume status in children with nephrotic syndrome

Cited by 14 publications

References 25 publications

Bioimpedance Resistance Indices and Cell Membrane Capacitance Used to Assess Disease Status and Cell Membrane Integrity in Children with Nephrotic Syndrome

Bioimpedance Resistance Indices and Cell Membrane Capacitance Used to Assess Disease Status and Cell Membrane Integrity in Children with Nephrotic Syndrome

Protein energy-wasting associated with nephrotic syndrome – the comparison of metabolic pattern in severe nephrosis to different stages of chronic kidney disease

Validating the use of bioimpedance spectroscopy for assessment of fluid status in children

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