Use of bioelectrical impedance techniques for monitoring nutritional status in patients on maintenance dialysis

doi:10.1053/jren.2000.7916

Journal of Renal Nutrition

Volume 10, Issue 3, July 2000, Pages 116-124

https://doi.org/10.1053/jren.2000.7916 Get rights and content

Abstract

Malnutrition continues to be an important correlate of survival in dialysis patients. Nutritional surveillance at the clinical level requires use of simple, reasonably accurate, and easily accessible techniques for multicompartmental body composition analysis. Unfortunately, although gold standard methodologies (body density by underwater weight, total body water by isotope dilution, bone mineral content by neutron activation, total body potassium by ⁴⁰K whole body gamma counting) provide very precise assessments, they are not applicable to routine clinical practice. Because of its availability and simplicity, bioelectrical impedance (BEI) has significant potential as a complement to standard anthropometric techniques in the nutritional monitoring of patients with chronic renal failure. Consistency of technique and standardization of BEI equipment are essential for reproducibility of results. Several studies have validated the use of total body water by BEI as a surrogate for isotope dilution methods in dialysis patients, whereas others have established an excellent correlation with the volume of distribution of urea as measured by urea kinetic volume. Bioimpedance analysis for measurement of lean body mass has been extensively evaluated in stable healthy populations, with results similar to those obtained using hydrodensitometry and total body potassium. In dialysis patients, accuracy is contingent on a stable hydration status and/or appropriate correction for changes in extracellular volume status over time. Recent publication of bioimpedance norms for the hemodialysis population allows better comparisons with the national reference population studied as part of the National Health and Nutrition Examination Survey III (US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD). BEI methodology is a practical bedside tool for assessment of body composition that provides more consistent and reproducible results than standard anthropometry alone.

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Cited by (45)

Bioimpedance analysis of vascular tissue and fluid flow in human and plant body: A review
2020, Biosystems Engineering
Bioimpedance is a non-invasive technique that finds diverse applications in living systems for tissue characterisation and diagnosis of disease. Biological tissue exposed under alternating current exhibits complex impedance behaviour that requires effective underlying biophysical and electrical models for such applications. Whilst bioimpedance has been widely explored in clinical applications on human body, its impact on agriculture industry is currently limited. Hence the paper reviews bioimpedance method with a focus on evaluating underlying biophysical models and analysis techniques, and identifying differences and similarities between human and plant-based applications. The application emphasis for the human body includes tissue composition, nutritional assessment, and analysis of the cardiovascular system for blood flow, cardiac output, and vascular compliance. The emphasis for applications in plants includes nutritional assessment and vascular tissue and flow characteristics. Bioimpedance is shown to be an invaluable tool in tissue engineering for both the systems. However, many challenges remain for both, including insufficient accuracy of biophysical models leading to false-positive diagnosis, limitation of analysis techniques to specific population groups or tissue type, and need for devices and technological improvements to improve accessibility to new applications such as precision agriculture. This review thus identifies critical technological and application gaps in bioimpedance for future research.
Effect of Change in Fluid Status Evaluated by Bioimpedance Techniques on Body Composition in Hemodialysis Patients
2018, Journal of Renal Nutrition
Citation Excerpt :
Many methods such as biochemical parameters, ultrasound, and relative blood volume monitoring have been used to assess normal fluid status.1 Bioimpedance (BI) as a noninvasive and inexpensive technique has been applied in clinical studies to assess fluid status and nutritional status for more than 20 years11-19. Several BI methods and mathematical models have been developed to predict20 or ascertain21 normal fluid status as well as to estimate body composition in HD patients.22
This prospective study uses calf bioimpedance spectroscopy (cBIS) to guide the attainment of dry weight (DW_cBIS) in chronic hemodialysis (HD) patients. The primary aim of this study was to evaluate whether body composition is altered when fluid status is reduced to DW_cBIS.
Target post-HD weight was gradually reduced from baseline (BL) until DW_cBIS was achieved. DW_cBIS was defined as the presence of both flattening of the curve of extracellular resistance and the attainment calf normalized resistivity in the normal range during the dialysis treatment. Extracellular volume (ECV), intracellular volume, and total body water (TBW) were measured using whole body BIS (Hydra 4200). Fluid overload, lean body mass, and fat mass were calculated according to a body composition model.
Seventy-three patients enrolled and 60 completed the study (55 ± 13 years, 49% male). Twenty-eight patients (25% diabetes) achieved DW_cBIS, whereas 32 patients (47% diabetes) did not. Number of treatment measurements were 16 ± 10 and 12 ± 13 studies per patient in the DW_cBIS and non-DW_cBIS groups, respectively. Although significant decreases in body weight and ECV were observed, lean body mass and FM did not differ significantly in both groups from BL to the end of study. ECV, ECV/TBW, and fluid overload were higher in the non-DW_cBIS than in the DW_cBIS group both at BL and at the end of study. Ratios of intradialytic changes in calf normalized resistivity, ECV, and ECV/TBW to ultrafiltration volume were significantly lower in diabetic than in non-diabetic patients.
This study shows that decreasing fluid status by gradual reduction of post-HD weight in both DW_cBIS and Non-DW_cBIS groups did not affect body composition significantly over a period of about 4 weeks.
Body composition analysis of patients on waiting list for cadaveric renal transplantation: A comparison of hemodialysis and peritoneal dialysis patients
2013, Transplantation Proceedings
Bioelectrical impedance analysis is a simple, noninvasive method of assessing body composition. Dialysis modality and selection of buffer type may have an impact on body composition. The aim of our study was to compare body compositions of patients from the waiting list for cadaveric renal transplantation according to the dialysis modality.
We examined a total of 152 (110 hemodialysis [HD] and 42 continuous ambulatory peritoneal dialysis [CAPD]) patients. Demographic data were collected from patient charts. The last 6 months routine laboratory evaluations including hemoglobin, serum creatinine, intact parathyroid hormone, albumin, C reactive protein, calcium, phosphorus were collected. Body compositions were measured using the Tanita BC-420MA Body Composition Analyzer (Tanita, Tokyo, Japan). We made a subanalysis of the CAPD group according to buffer choices as follows: lactate-buffered (n = 16) and bicarbonate/lactate–buffered (n = 26) solution users.
The body weight (P = .022), body mass index (BMI; 25.8 ± 4.7 vs 23.4 ± 4.9 kg/m², P = .009), muscle mass (P = .01), fat-free mass (P = .013), and visceral fat ratio (9.5 ± 5.4 vs 7.3 ± 4.1 %, P = .022) were significantly higher in the CAPD group. Total body water of CAPD patients were also higher (P = .003), but total body water ratios of HD and CAPD groups were similar. Fat and fat-free mass ratios of patient groups were also similar. Comparing CAPD subgroups we observed that patients using bicarbonate/lactate–buffered solutions had higher body weights (P = .038), BMI (27.1 ± 5 vs 23.7 ± 3.5 kg/m², P = .018) values, and visceral fat ratios (8.0 ± 5.2 vs 4.6 ± 2.5 %, P = .023). These patients also tend to have higher fat mass without statistical significance (P = .074). Fat, muscle, and fat-free mass total body water ratios of peritoneal dialysis subgroups were similar.
We believe that body composition analysis should be used as a complementary method for assessing nutritional status of PD and CAPD patients as body weight or BMI measurements do not reflect fat, muscle masses, and visceral fat ratios in these patients. Stable, well nourished CAPD patients should be closely observed and be encouraged to increase daily exercise and/or decrease calorie intake from other sources to decrease risks associated with abdominal obesity.
Assessment of Protein and Energy Nutritional Status
2013, Nutritional Management of Renal Disease
The Phase Angle and Mass Body Cell as Markers of Nutritional Status in Hemodialysis Patients
2010, Journal of Renal Nutrition
Citation Excerpt :
Low PA values have also been associated with mortality in patients with HIV and cancer of the colon and pancreas.27,28 The advantage of using BCM in the evaluation of nutritional status is that, unlike FFM, it does not include extracellular water (which is often increased in CKF patients and is a frequent cause of the overestimation of the nutritional status).29 Reductions in the visceral or somatic protein mass may be masked by a concurrent increase in extracellular water.
Bioelectrical impedance analysis (BIA) is a fast, noninvasive method for assessing body composition, and its role in the evaluation of nutritional status in haemodialysis (HD) has been studied. This study aimed to compare BIA parameters to clinical, biochemical, and anthropometric markers of nutrition in HD patients, such as subjective global assessment modified for renal disease (SGA-1), serum albumin, body mass index (BMI), percent of standard body weight (%SBW), deviation of triceps skinfold thickness (TSF), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC) from the standard value (50th percentile), anthropometry-derived fat (FM-A), and fat-free mass (FFM-A).
BIA was performed 30 minutes after a HD session and the reactance (Xc), resistance (R), phase angle (PA), body cell mass (BCM), fat mass (FM-BIA), and fat-free mass (FFM-BIA) values were recorded. The prevalence of malnutrition was estimated according to PA and percent of BCM. The correlation between methods was assessed through Pearson's correlation coefficient and Bland and Altman analysis.
A total of 58 patients were studied (30 women and 28 men; mean age of 49.2 ± 14.8 years). The mean PA was 6.19 ± 1.33 degrees and the mean percent of BCM was 33.75 ± 5.91%. The prevalence of malnutrition was 17.5% and 43.9% according to the PA and percent of BCM, respectively. PA had a negative correlation with age and SGA-1 score and a positive correlation with percent SBW, MAC, MAMC, FFM-A, and albumin. Percent of BCM had a negative correlation with age, MAC, MAMC and FM-A and a positive correlation with FFM-A and albumin. A significant correlation between FFM-A and FFM-BIA was observed, as well as between FM-A and FM-BIA.
BIA indexes reflected nutritional state. PA and BCM seem to be less influenced by changes in volume and can be used for nutritional assessments of dialysis patients.
Body composition analysis with bioelectric impedance in adult Indians with ESRD: Comparison with healthy population
2006, Kidney International
Citation Excerpt :
Both malnutrition and overhydration are associated with reduced PA, but can be differentiated with the help of BIVA.14 Vector shortening and narrow PA indicate a state of overhydration, whereas vector lengthening and narrow PA indicate loss of soft tissue mass and malnutrition.14-16,31,37-40 BIVA can be thus used to assess ultrafiltration adequacy during HD and hydration in peritoneal dialysis patients.15, 16
Evaluation of body composition provides clinically useful information in several diseases including chronic kidney disease. Bioimpedance analysis (BIA) is a simple, cheap, and noninvasive tool for monitoring body composition. We performed BIA in 451 healthy adults and 162 end-stage renal disease (ESRD) patients. Resistance (R) and reactance (Xc) values were obtained at 50-kHz frequency using a tetrapolar impedance meter. Body compartments were derived using population-specific regression equations. Phase angles (arctan Xc/R) were calculated and impedance vector distribution was determined using the RXc graph method. Compared to healthy population, ESRD patients had similar post-dialysis resistance with lower reactance and phase angle, indicating decreased soft tissue mass and inadequate ultrafiltration. BIA equations estimated decreased fat mass index and intracellular water, whereas the total body and extracellular water percentages were increased. Sex-specific reference RXc plots with 95, 75, and 50% tolerance ellipses were drawn for the healthy population. A significant difference was noted in the vector positions and 95% confidence ellipses of the two sexes and body mass indices of ≤25 and >25. In conclusion, we present the reference BIA parameters for Indian population. ESRD patients show significant body compartment alterations. The RXc score graph can differentiate ESRD patient from normal controls and can be used to monitor nutrition and hydration status.

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ReviewUse of bioelectrical impedance techniques for monitoring nutritional status in patients on maintenance dialysis

Abstract

Review
Use of bioelectrical impedance techniques for monitoring nutritional status in patients on maintenance dialysis