Use of body composition measurements to guide the assessment of dry weight in anuric dialysis patients: improvements in blood pressure control

Abstract

PurposeFluid management using a body composition monitor (BCM) based on bioimpedance spectroscopy has been found to be beneficial for maintenance hemodialysis (MHD) patients. Our purpose was to provide a management procedure for the adjustment of post-dialysis overhydration (OHpost) and to evaluate whether this approach could improve blood pressure.MethodsPost-dialysis fluid status was assessed weekly using the BCM. The reference value of OHpost and the flow procedure for post-dialysis target weight (PDTW) adjustment were established via measurements of OHpost in 60 normotensive MHD patients. In the interventional study, we adjusted the PDTW of hypertensive patients to the optimal OHpost range, with a 0.2–0.5 kg change in PDTW per week.ResultsThis observational study included 130 anuric MHD patients, of whom 60 were in the pre-dialysis systolic blood pressure (sBPpre) < 140 mmHg group. On multivariate logistic regression analysis, we found that only OHpost was significantly associated with sBPpre ≥ 140 mmHg (odds ratio = 2.293, p = 0.000). Patients in the OHpost < −1.8 L group were mainly male and younger, and had higher post-dialysis diastolic blood pressure, ultrafiltration volume, levels of nutrition markers (serum albumin and creatinine), body mass index, and lean tissue index (LTI). On multiple stepwise regression analysis, only the change in LTI was found to be an independent predictor of OHpost [R2 0.208, β = −0.196, 95% CI (−0.296, −0.095), p < 0.001]. The reference value of OHpost was found to deviate by − 2.5–0.5 L from that of normotensive patients. At the end of the study, the systolic blood pressure of 38 patients was less than 140 mmHg after PDTW adjustment. The changes in OHpost from the initial to last adjustment were significant (t = 5.431, p < 0.001), with a substantial decrease in the sBPpre (t = 11.208, p < 0.001).ConclusionsAssessment of OHpost and LTI using a BCM with a patient-specific optimal PDTW adjustment flow can lead to significantly better control of hypertension in anuric MHD patients.

Analysis of Change in Body Composition in Diabetic Patients vs non-Diabetic Patients

“…It particularly gives an idea about the body fat and muscle mass. 8 Principle of impedance or resistance revolves around the passage of voltage through the body. 15 More muscular the body is more is water component and less is the resistance.…”

“…Various components could be measured or calculated by this method. 8 The change in parameters could be explained on the mechanism of diabetes. Even the illness with good control with medications has been associated with changes in fat and lipid component of the body on macro level as well as biochemical level.…”

“…7 Measurement of total body fat, visceral fat, skeletal muscle mass and obesity degree have been under the interest of clinicians, nutritionist and researchers to look for their significance in various metabolic disorders including the diabetes. 8,9 Considerable literature is availablethat link the presence of diabetes mellitus with changes in body composition. A study done by physiologists in India concluded that patients with diabetes mellitus have more ectopic fat on the expense of skel et al, muscles.…”

Bioelectrical Impedance Analysis Derived-Phase Angle as a Pragmatic Tool to Detect Protein Energy Wasting among Multi-Ethnic Hemodialysis Patients

“…The entire BIA measurement process took approximately 5 min. A measurement quality value of ≥90% (a smooth, dome shape of a Cole-Cole plot) indicates a successful measurement [33,34]. The PhA value [arctangent (Xc/R) × (180/π)], expressed in degree ( • ) was obtained from the BIA reading measured at the frequency of 50 kHz, in which the maximum reactance occurs, whereby the body cells are strongest in resisting the current, providing the highest PhA value [35].…”