Clinical usefulness of bioimpedance analysis for assessing volume status in patients receiving maintenance dialysis

Abstract

Chronic volume overload is associated with left ventricular hypertrophy and high cardiovascular mortality in patients undergoing dialysis. Therefore, estimating body fluid status is important in these patients. However, most dry-weight assessments are still performed clinically, while attempts have been made to measure the volume status and dry weight of patients undergoing dialysis using bioimpedance analysis (BIA). BIA uses the electrical properties of the human body to alternate current flow and measures resistance values to estimate body water content and composition. BIA is divided into single-frequency BIA, multi-frequency BIA, and bioimpedance spectroscopy (BIS) according to the number of frequencies used, and into whole-body and segmental BIA according to whether or not the whole body is divided into segments. Extracellular water (ECW), intracellular water, and total body water (TBW) contents can be measured with BIA. Dry weight can be estimated by measuring the volume overload of the patient through the ECW/TBW and ECW-to-body weight ratios. Other estimation methods include the normovolemia/hypervolemia slope method, a resistance-reactance (RXc) graph, overhydration measurements using a body composition monitor, and calf BIS. In this review, we will examine the principles of BIA, introduce various volume status measurement methods, and identify the optimal method for patients undergoing dialysis.

Evaluating of altered hydration status on effectiveness of body composition analysis using bioelectric impedance analysis

“…It has been revealed that BIA is a useful, easily applicable, and inexpensive tool for the evaluation of body composition of obese [10], cardiometabolic disorders [1][2][3][4], cancer [8], and hemodialysis patients [18]. Obtaining confidential information with regarding specific proportion of each section of body composition (TBW, FFM, %FM and FM) in health and also some disorder is a continue interest of clinical and scientist.…”

Association of bioelectric impedance analysis body composition and disease severity in COVID-19 hospital ward and ICU patients: The BIAC-19 study

“…In particular, for ICU patients, in whom fluid overload is common and has prevented BIA measurements from becoming a standard of practice. However, we circumvented this problem by using a multi-frequency BIA device (InBody S10), to enable differentiation between various fluid compartments [28,49,50], adjustment for the time from hospital admission to measurement, and recalculation of body composition to dry weight to reduce the effect of overestimating LBM by fluid overload. We recognize that under ideal circumstances, serial BIA measurements provide more details on the course of loss of muscle mass and fluid overload in critically ill patients.…”

“…However, methods to calculate dry body weight values have been described for dialysis patients, where fluid overload is prevalent [ 25 , 26 ]. The ratio between extracellular and total body water, as an indicator of hydration status, is easy to use, intuitive and validated as a predictor of survival in these patients [ 27 , 28 ]. This provides a theoretical justification to apply this technique to ICU patients.…”

Bioelectrical impedance analysis for perioperative water management in adult cardiovascular valve disease surgery

“…BIA has been applied for the water management of hemodialysis patients and also recently for the water management of heart failure and cardiac surgery patients [16][17][18][19][20][21][22].…”

“…According to several reports on BIA in clinical studies, the phase angle (PA), one type of BIA readout, shared a correlation with a nutrition marker and was a potential postoperative risk marker for cardiac surgery [12][13][14][15]. Studies on the differences in water behavior with some kinds of diuretics found that one readout of BIA, the edema index (EI), being the ratio of extracellular water to total body water, can predict the amount of fluid reduction needed for patients with acute heart failure and chronic renal disease [16][17][18][19][20][21][22]. We hypothesized that perioperative water management could be improved by a better understanding of perioperative water behavior through BIA.…”