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Abstract
Introduction: Electrical bioimpedance can be used to establish the hydration and nutritional state in haemodialysis. Assessing the hydration status of patients is habitually done as a “clinical art” using the concept of “dry weight”. There are few studies that examine the concordance between dry weight estimated clinically and the dry weight deduced post-bioimpedance analysis.Material and methods: 36 patients were studied (26 men and 10 women). Electrical bioimpedance vector analysis was performed before and 30’ af-ter midweek dialysis, measuring weight, total water and its distribution, phase angle, Na/K ratio, and the position of each patient’s vector in the sphere nor-mogram: percentiles 50.75 and 95. Dry weight was estimated according to the subjective assessment of the nephrologist, nurse and patient. Furthermore, in 12 stable patients the bioimpedance analysis con-tinued for 4 weeks. Results: The age was 69.6±12.5 (r=29-89). Weight was 73.1±14.1 predialysis, and 70.4±13.6 postdialysis. Total body water was 24.7±2.8 L/m (53.7±8.2% of weight); 22.1±3.0 L (56.2±5.9% of weight) corresponded to extracellular water and 17.4±3.8 L/m to intracellular water. Following haemodialysis, total water fell to 22.8±2.4 L/m (51.8±8.6% of weight) (23.5±2.2 L in men; and 21.5±3 L in women) of which 19.6±2.5 L (54.3±5.8% of weight) corresponded to extracellular water and 16.7±3.3 to intracellular water. One man and 5 women exceeded the highest reference value. Posthaemodialysis weight was 70.4±13.6, slightly higher than the established dry weight: 70.2±13.4 (p=0.02). The phase angle was <4 in 9 patients (25%) and Na/K exchange in 13 patients (36%) was >1.2, indicating malnutrition.
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Copyright (c) 2013 María Teresa Tristán, Mª Luisa Garcinuño Martín, Reyes González de Antonio, Elvira Roig Gaspar, Daniel Corbacho Barrenechea
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References
- Piccoli A, para Itailan Hemodialysis-Bioelectrical Impedance Analysis Study Group. Identifi cation of operational clues to dry weight prescription in hemodialysis using bioimpedance vector analysis. Kindey Int 53: 1036-1043,1998.
- Cigarrán S, Barril G, Cirugeda A, Herraiz I, Selgas R. Evaluación del estado nutricional de los pacientes renales y ajustes del peso seco en HD: papel de la Bioimpedancia. Electron J Biomed. 2004;1:16-23.
- Chen YC, Chen HH, Yeh JC, Chen SY. Adjusting the dry weigth by extracellular volume and body composition in hemodialysis patients. Nephron. 2002; 92(1):91-6.
- Chertow G. Lazarus JM, Lew NL, Lihong MA, Lowrie EG. Bioimpedance norms for hemodialysis population. Kidney Int. 1997;52:1617-1621.
- Hoffer EC, Meador CK, Simpson DC. Correlation of whole-body impedance with total body water volume. J.A ppl. Physiol. 1969;27:531-534.
- Arias M. La bioimpedancia como valoración del peso seco y el estado de hidratación. Dial Traspl. 2010; 31(4).137-9.
- Vasko R, Müller GA, Ratliff BB, Jung K, Gaucczinski S, Koziolek MJ. Clinical judgment is the most important element in overhydration assessment of chronic hemodialysis patients. Clin. Exp. Nephrol. 2012, Nov 29 [DOI 10.1007/s 10157-012-0745-9].
- Liu L, long G, Ren J, Li J, Xu J, lei J, Li M, Qiu M, Yuan P, Sun W, Lin S, Liu W, Sun Y, Ma Y, Mao Y, Shen Y, Zuo L. A randomized control-led trial of long term effect of BCM guided fluid management in MHD patients (BOCOMO study): rationales and study design. BCM Nephrol. 2012, 13:120-7.
References
Piccoli A, para Itailan Hemodialysis-Bioelectrical Impedance Analysis Study Group. Identifi cation of operational clues to dry weight prescription in hemodialysis using bioimpedance vector analysis. Kindey Int 53: 1036-1043,1998.
Cigarrán S, Barril G, Cirugeda A, Herraiz I, Selgas R. Evaluación del estado nutricional de los pacientes renales y ajustes del peso seco en HD: papel de la Bioimpedancia. Electron J Biomed. 2004;1:16-23.
Chen YC, Chen HH, Yeh JC, Chen SY. Adjusting the dry weigth by extracellular volume and body composition in hemodialysis patients. Nephron. 2002; 92(1):91-6.
Chertow G. Lazarus JM, Lew NL, Lihong MA, Lowrie EG. Bioimpedance norms for hemodialysis population. Kidney Int. 1997;52:1617-1621.
Hoffer EC, Meador CK, Simpson DC. Correlation of whole-body impedance with total body water volume. J.A ppl. Physiol. 1969;27:531-534.
Arias M. La bioimpedancia como valoración del peso seco y el estado de hidratación. Dial Traspl. 2010; 31(4).137-9.
Vasko R, Müller GA, Ratliff BB, Jung K, Gaucczinski S, Koziolek MJ. Clinical judgment is the most important element in overhydration assessment of chronic hemodialysis patients. Clin. Exp. Nephrol. 2012, Nov 29 [DOI 10.1007/s 10157-012-0745-9].
Liu L, long G, Ren J, Li J, Xu J, lei J, Li M, Qiu M, Yuan P, Sun W, Lin S, Liu W, Sun Y, Ma Y, Mao Y, Shen Y, Zuo L. A randomized control-led trial of long term effect of BCM guided fluid management in MHD patients (BOCOMO study): rationales and study design. BCM Nephrol. 2012, 13:120-7.