Comparison of intradialytic changes in weight and fluid status

Lindley, Elizabeth; Keane, David; Schneditz, Daniel

doi:10.1111/nep.12671

Cited by 5 publications

(4 citation statements)

References 1 publication

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“…Whereas the use of BCM cannot replace good clinical judgement, it can help prevent potentially harmful adjustments in target weight based on deceptive signs and symptoms. In addition, serial BCM readings allow changes in fluid status to be monitored accurately, provided a consistent measurement protocol is used [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…The measurements are non-invasive, well tolerated, inexpensive and easy to perform. If carried out according to a standardised protocol [ 29 ], BCM measurements are highly reproducible, allowing changes in lean body mass to be distinguished from changes in fluid status and adjustments in target weight to be made before symptoms occur. Further studies are required to demonstrate the benefits of using BCM in guiding fluid management and improving clinical outcomes in this vulnerable population.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…BCM measurements are used primarily for determination of normohydration-weight of HD patients when setting or reviewing target weights and are saved using the Fluid Management Tool (FMT) software (Fresenius Medical Care, Bad Homburg, Germany). Referrals for measurement are on indication and they are made both pre- and post-dialysis, with post-dialysis measurements being made after sufficient time for redistribution of fluid [25]. This has resulted in the collection of longitudinal data showing changes in lean tissue, adipose tissue and normohydration-weight.…”

Section: Methodsmentioning

confidence: 99%

Changes in Body Composition in the Two Years after Initiation of Haemodialysis: A Retrospective Cohort Study

et al. 2016

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Malnutrition is common in haemodialysis (HD) and is linked to poor outcomes. This study aimed to describe changes in body composition after the initiation of HD and investigate whether any routinely collected parameters were associated with these changes. The study cohort came from the HD population of a single centre between 2009 and 2014. Body composition measurements were obtained from a database of bioimpedance results using the Body Composition Monitor (BCM), while demographics and laboratory values came from the renal unit database. Primary outcomes were changes in normohydration weight, lean tissue mass and adipose tissue mass over the two years after HD initiation. A total of 299 patients were included in the primary analyses, showing an increase in adipose tissue, loss of lean tissue and no significant change in normohydration weight. None of the routinely collected parameters were associated with the lean tissue changes. Loss of lean tissue over the first year of dialysis was associated with increased mortality. The results showing loss of lean tissue that is not limited to those traditionally assumed to be at high risk supports interventions to maintain or improve lean tissue as soon as possible after the initiation of HD. It highlights the importance of monitoring nutrition and the potential for routine use of bioimpedance.

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“…El-Kateb et al reported a similar dataset to that presented here (El-Kateb and Davenport, 2015) with contrasting results, including a significant bias and limits of agreement three times larger than those observed in this study. This discrepancy seems likely to be due to artefactual BCM measurements and highlights the need for some expertise when making measurements (Lindley et al, 2015). The BCM validation literature also suggests that a bias is introduced into measurements of LTM and ATM when measurements are made immediately after dialysis but within 30 minutes this becomes non-significant.…”

Section: Discussionmentioning

confidence: 99%

The Body Composition Monitor: a flexible tool for routine fluid management across the haemodialysis population

Keane

Baxter

Lindley

et al. 2017

Biomed. Phys. Eng. Express

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Bioimpedance measurements with the Body Composition Monitor (BCM) have been shown to improve fluid management in haemodialysis. However, there is a lack of a sufficiently robust evidence-base for use of the BCM outside of standard protocols. This study aims to characterise BCM measurement variation to allow users to make measurements and interpret the results with confidence in a range of clinical scenarios. BCM measurements were made in 48 healthy controls and in 48 stable haemodialysis patients before and immediately after dialysis. The effect of utilising alternative measurement paths was assessed using mixed effects models and the effect of measuring post-dialysis was assessed by comparing changes in BCM-measured overhydration (OH) with weight changes over dialysis. The data from healthy controls suggest that there is no difference in BCM-measured OH between all the whole-body paths other than the foot-to-foot measurement. Dialysis patients showed similar results other than having higher BCM-measured OH when measured across the site of a vascular access. There was good agreement between BCM-measured OH and change in weight, suggesting post-dialysis measurements can be utilised. These results suggest BCM protocols can be flexible regarding measurement paths and timing of measurement to ensure as many patients as possible can benefit from the technology.

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Comparison of intradialytic changes in weight and fluid status

Cited by 5 publications

References 1 publication

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

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

Changes in Body Composition in the Two Years after Initiation of Haemodialysis: A Retrospective Cohort Study

The Body Composition Monitor: a flexible tool for routine fluid management across the haemodialysis population

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