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Schneditz D, Mussnig S, Krenn S, Hecking M. Revisiting the concept of constant tissue conductivities for volume estimation in dialysis patients using bioimpedance spectroscopy. Int J Artif Organs 2023; 46:67-73. [PMID: 36550616 DOI: 10.1177/03913988221145457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
RATIONALE Current estimation of body fluid volumes in hemodialysis patients using bioimpedance analysis assumes constant specific electrical characteristics of biological tissues despite a large variation in plasma Na+ concentrations [Na+], ranging from 130 to 150 mmol/L. Here, we examined the potential effect of variable [Na+] on bioimpedance-derived volume overload. METHOD Volumes were calculated from published whole-body extra- and intracellular resistance data and relationships using either "standard" or "revised" specific electrical characteristics modeled as functions of [Na+]. RESULT With "standard" assumptions, volumes increased with increasing [Na+]. The increase in volume overload was about 0.5 dm3 and 3% of extracellular volume per 10 mmol/dm3 of [Na+] in a 75 kg patient. This increase was abolished when the same bioimpedance data were analyzed under "revised" conditions. DISCUSSION The overestimation in extracellular volume overload in the range of 0.5 dm3 per 10 mmol/dm3 [Na+] perfectly matches the positive relationship determined in a large cohort of hemodialysis patients. The bias may be considered moderate when interpreting data of individual patients, but may become important when comparing data of larger patient groups. The bias disappears when analysis of bioimpedance data accounts for differences in tissue electrical properties, using individual [Na+].
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Affiliation(s)
- Daniel Schneditz
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, Graz, Austria
| | - Sebastian Mussnig
- Department of Medicine III, Division for Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Simon Krenn
- Department of Medicine III, Division for Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria.,Center for Health & Bioresources, Medical Signal Analysis, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Manfred Hecking
- Department of Medicine III, Division for Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
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2
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Schotman J, Rolleman N, van Borren M, Wetzels J, Kloke H, Reichert L, de Boer H. Accuracy of Bioimpedance Spectroscopy in the Detection of Hydration Changes in Patients on Hemodialysis. J Ren Nutr 2023; 33:193-200. [PMID: 34922812 DOI: 10.1053/j.jrn.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/16/2021] [Accepted: 11/03/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The body composition monitor (BCM) is a bioimpedance spectroscopy device, specifically developed for patients on hemodialysis (HD) to improve ultrafiltration (UF) programming, based on an objective assessment of the degree of overhydration (OH) at the start of HD. However, its acceptance in clinical practice remains limited because of concerns about the accuracy at the individual level. The aim of this study is to examine the performance of the BCM and to identify means of improvement. METHODS Precision of the OH estimate was assessed by 6 consecutive measurements in 24 patients on HD. Accuracy was examined in 45 patients, by comparing the change in OH (ΔOH) during HD with UF volume. Accuracy was considered acceptable if the volume error in individual patients was ≤0.5 L. RESULTS The OH estimate had an analytical precision of 1.0 ± 0.4%. The correlation between UF volume and ΔOH was moderate (Slope = 0.66, R2 = 0.44, P < .001) and indicated underestimation of UF volume, in particular for high UF volumes. Accuracy at individual level was highly variable. A volume error >0.5 L occurred in 44% of patients. Accuracy improved over the course of HD, with a decrease in total error range from 2.3 L in the first hour to 1.1 L in the final hour of HD. CONCLUSIONS The accuracy of BCM volume change estimates is highly variable and below requirements of daily practice. Improvement may be achieved by a switch to an end-of-HD measurement.
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Affiliation(s)
- Jantine Schotman
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands.
| | - Nick Rolleman
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Marcel van Borren
- Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jack Wetzels
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Heinrich Kloke
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Louis Reichert
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Hans de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
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3
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Schotman JM, Hazeleger LR, van Borren MMGJ, Wetzels JFM, Kloke HJ, Reichert LJM, Doorenbos CJ, de Boer H. Optimal current frequency for the detection of changes in extracellular water in patients on hemodialysis by measurement of total body electrical resistance. Clin Nutr ESPEN 2021; 43:302-307. [PMID: 34024531 DOI: 10.1016/j.clnesp.2021.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/05/2021] [Accepted: 03/15/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS Measurement of total body electrical resistance (TBER) to an alternating current is useful to monitor extracellular water (ECW) in patients on hemodialysis (HD). Which current frequency is preferable is subject of ongoing debate. The aim of this study was to quantify the implications of TBER measurements at current frequencies ranging from 0 to 1000 kHz for ECW monitoring in patients on HD. METHODS Bioimpedance spectroscopy measurements were performed in 39 patients on HD using the Body Composition Monitor (BCM, Fresenius Medical Care). TBER data at 5, 50, 200, 500, and 1000 kHz were compared with the extrapolated TBER at 0 kHz (TBER0) assessed by Cole-Cole analysis. Sensitivity of each TBER configuration was evaluated at individual level, by assessment of the smallest ultrafiltration (UF) volume that induced a significant change in TBER, i.e. a change in TBER ≥ 2.7%. RESULTS TBER precision was very high for all frequencies, with coefficients of variation of 0.25%-0.28%. Baseline TBER decreased with increasing current frequency. TBER was 2.9% lower at 5 kHz (P < 0.001), 11.6% lower at 50 kHz, and up to 22.0% lower at 1000 kHz. This pattern is attributed to a progressive increase in intracellular current conduction at higher frequencies. Sensitivity to volume changes induced by UF also decreased with increasing current frequency. At 0 and 5 kHz, an UF volume ≤ 0.5 L was sufficient to induce a significant increase in TBER in 87% of patients. This decreased to 69% at higher frequencies. CONCLUSION ECW monitoring by TBER requires measurement at 5 kHz or less to ensure optimal performance.
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Affiliation(s)
- J M Schotman
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands.
| | - L R Hazeleger
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - M M G J van Borren
- Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, the Netherlands
| | - J F M Wetzels
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H J Kloke
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L J M Reichert
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - C J Doorenbos
- Department of Internal Medicine, Deventer Hospital, Deventer, the Netherlands
| | - H de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
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Schotman J, van Borren M, Wetzels J, Kloke H, Reichert L, Doorenbos CJ, de Boer H. Impact of diffusion, ultrafiltration, and posture on total body electrical resistance in patients on hemodialysis. J Appl Physiol (1985) 2021; 130:318-324. [PMID: 33211631 DOI: 10.1152/japplphysiol.00688.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Monitoring of hydration in patients on hemodialysis (HD) by currently available bioelectrical impedance analysis (BIA) methods is hampered by limited accuracy. This may be caused by changes in total body electrical resistance (TBER) that are induced by processes other than ultrafiltration (UF). To identify these sources of error, we examined the impact of UF, diffusion, and postural change (PC), separately. Extracellular TBER (TBERe) was measured by bioimpedance spectroscopy every 30 min in 23 patients on HD, for 2 h during diffusion-only (DO), followed by 2-h UF-only (UFO). The impact of PC from upright to semi-recumbent position was assessed by a 2-h TBERe measurement on the day after HD. TBERe increased by 23.5 ± 12.4 Ω (P < 0.001) during DO and by 40.0 ± 16.2 Ω (P < 0.001) during UFO. PC, evaluated on a separate day, was associated with an increase in TBERe of 27.6 ± 26.0 Ω (P < 0.001). TBERe changes during DO were mainly attributed to PC and to a lesser extent to electrolyte exchange. Extrapolation of the data to a conventional 4-h HD session indicates that about 32% of the total increase in TBERe is not related to UF. In conclusion, a significant part of the increase in TBER during HD is not related to UF but can be attributed to other processes such as the effects of PC and diffusion-related electrolyte exchange. These factors have to be taken into account when TBER-guided UF is considered.NEW & NOTEWORTHY Current BIA methods have limited accuracy in patients on HD. This may be related to the incorrect assumption that all changes in total body electrical resistance (TBER) are caused by changes in body water volumes. The present study indicates that two-thirds of the change in TBER during a conventional 4-h HD session can be attributed to fluid extraction, and that the remaining part is caused by other processes such as postural change and electrolyte exchange. This may cause volume prediction errors when not recognized.
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Affiliation(s)
- Jantine Schotman
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marcel van Borren
- Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jack Wetzels
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Heinrich Kloke
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Louis Reichert
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Hans de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
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Mitsides N, McHugh D, Swiecicka A, Mitra R, Brenchley P, Parker GJM, Mitra S. Extracellular resistance is sensitive to tissue sodium status; implications for bioimpedance-derived fluid volume parameters in chronic kidney disease. J Nephrol 2020; 33:119-127. [PMID: 31214996 PMCID: PMC7007413 DOI: 10.1007/s40620-019-00620-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/06/2019] [Indexed: 01/01/2023]
Abstract
Multifrequency bioimpedance spectroscopy (BIS) is an established method for assessing fluid status in chronic kidney disease (CKD). However, the technique is lacking in predictive value and accuracy. BIS algorithms assume constant tissue resistivity, which may vary with changing tissue ionic sodium concentration (Na+). This may introduce significant inaccuracies to BIS outputs. To investigate this, we used 23Na magnetic resonance imaging (MRI) to measure Na+ in muscle and subcutaneous tissues of 10 healthy controls (HC) and 20 patients with CKD 5 (not on dialysis). The extracellular (Re) and intracellular (Ri) resistance, tissue capacitance, extracellular (ECW) and total body water (TBW) were measured using BIS. Tissue water content was assessed using proton density-weighted MRI with fat suppression. BIS-derived volume indices were comparable in the two groups (OH: HC - 0.4 ± 0.9 L vs. CKD 0.5 ± 1.9 L, p = 0.13). However, CKD patients had higher Na+ (HC 21.2 ± 3.0, CKD 25.3 ± 7.4 mmol/L; p = 0.04) and significantly lower Re (HC 693 ± 93.6, CKD 609 ± 74.3 Ohms; p = 0.01); Ri and capacitance did not vary. Na+ showed a significant inverse linear relationship to Re (rs = - 0.598, p < 0.01) but not Ri. This relationship of Re (y) and Na+ (x) is described through equation y = - 7.39x + 814. A 20% increase in tissue ionic Na+ is likely to overestimate ECW by 1.2-2.4L. Tissue Na+ concentration has a significant inverse linear relationship to Re. BIS algorithms to account for this effect could improve prediction accuracy of bioimpedance derived fluid status in CKD.
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Affiliation(s)
- Nicos Mitsides
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
- Nephrology Department, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.
- NIHR Devices for Dignity Medical Technology Co-operative, Sheffield, UK.
| | - Damien McHugh
- Quantitative Biomedical Imaging Laboratory, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Agnieszka Swiecicka
- Andrology Research Unit, Division of Gastroenterology, Endocrinology and Diabetes, School of Medicine, Faculty of Biology, Medicine and Healthy, University of Manchester, Manchester, UK
| | | | - Paul Brenchley
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Geoff J M Parker
- Quantitative Biomedical Imaging Laboratory, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Bioxydyn Limited, Manchester, UK
| | - Sandip Mitra
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Devices for Dignity Medical Technology Co-operative, Sheffield, UK
- Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester, UK
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6
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Schotman JM, van Borren MMGJ, Kooistra MP, Doorenbos CJ, de Boer H. Towards personalized hydration assessment in patients, based on measurement of total body electrical resistance: Back to basics. Clin Nutr ESPEN 2019; 35:116-122. [PMID: 31987103 DOI: 10.1016/j.clnesp.2019.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Assessment of tissue hydration by conventional bioelectrical impedance analysis (BIA) has produced conflicting results because of flaws in the algorithms that are used to translate measurements of total body electrical resistance (TBER) into liters of body water. This type of error can be eliminated by a return to the TBER measurement itself, without attempting to convert Ohms into liters of body water. Aims of this study were to quantify tissue hydration based on TBER, to establish TBER normal values (TBERnorm), to improve the prediction of TBERnorm values in individual patients, and to evaluate this approach in patients on hemodialysis (HD). METHODS TBERnorm values were obtained in 213 healthy controls and corrected for body height (H-TBERnorm). Inter-individual H-TBERnorm variability was reduced by correction for arm muscle cross-sectional area (AMA). Performance of this approach was evaluated in 94 patients on HD. RESULTS H-TBERnorm was inversely related to AMA. Correction for AMA reduced the H-TBERnorm standard deviation by 31% in men and 23% in women. When applied to patients on HD, H-TBER changes within subjects were inversely related to ultrafiltration volumes, with a mean R2 of 0.95 ± 0.04 in men and 0.93 ± 0.07 in women. Clinically significant H-TBER increments occurred after volume reductions of 0.39 ± 0.25 L in men and 0.37 ± 0.18 L in women. CONCLUSIONS TBER measurements, corrected for height and AMA, have the potential to become an objective and sensitive method to assess hydration in patients. Its clinical value remains to be shown in intervention studies.
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Affiliation(s)
- J M Schotman
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands.
| | - M M G J van Borren
- Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, the Netherlands
| | - M P Kooistra
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - C J Doorenbos
- Department of Internal Medicine, Deventer Hospital, Deventer, the Netherlands
| | - H de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
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7
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Schotman JM, van Borren MMGJ, Wetzels JFM, Kloke HJ, Reichert LJM, de Boer H. Assessment of Plasma Resistivity as a Surrogate for Extracellular Fluid Resistivity: Analytical Performance and Impact of Fluid Composition. Ann Biomed Eng 2019; 47:1463-1469. [PMID: 30891658 DOI: 10.1007/s10439-019-02246-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/12/2019] [Indexed: 11/29/2022]
Abstract
Bio-electrical impedance analysis (BIA) is frequently used to assess body composition in man. Its accuracy in patients is limited, possibly because the employed algorithms are based on the assumption that total body electrical resistance (TBER) is exclusively related to body water volume, and that variation in fluid composition and its effect on fluid resistivity can be ignored. This may introduce substantial calculation errors. The aim of this study was to develop an objective method to assess plasma resistivity (ρplasma) based on measurements by a conductivity probe, as a surrogate for extracellular fluid resistivity (ρe). Sample measurements were standardized at body temperature. Analytical variation was 0.6% within runs and 0.9% between runs. The critical difference, i.e. the smallest difference needed to consider changes within individuals significant, was 1.8% for measurements within runs and 4.3% for measurements between runs. The normal range was defined by a mean ± SD of 66.9 ± 1.8 Ω cm. Multiple regression demonstrated that ρplasma was inversely related to plasma sodium and chloride concentrations, and positively related to total protein (overall R2 = 0.92, p < 0.001). In conclusion, ρplasma measurements were sufficiently robust to be useful as a tool to examine and improve the validity of BIA in clinical settings.
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Affiliation(s)
- J M Schotman
- Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6800 TA, Arnhem, The Netherlands.
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - J F M Wetzels
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H J Kloke
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L J M Reichert
- Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6800 TA, Arnhem, The Netherlands
| | - H de Boer
- Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6800 TA, Arnhem, The Netherlands
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Yashiro M, Kotera H. Novel equations for bioimpedance spectroscopy to calculate body fluid volume based on the agreement between body weight and extracellular water change before and after hemodialysis as a guide. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0203-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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9
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Ismail AH, Schlieper G, Walter M, Floege J, Leonhardt S. Knee-to-knee Bioimpedance Measurements to Monitor Changes in Extracellular Fluid in Haemodynamic-unstable Patients During Dialysis. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2019; 10:55-62. [PMID: 33584883 PMCID: PMC7531213 DOI: 10.2478/joeb-2019-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Indexed: 06/12/2023]
Abstract
The feasibility of bioimpedance spectroscopy (BIS) techniques for monitoring intradialytic changes in body fluids is advancing. The aim of this study was to compare the knee-to-knee (kkBIS) with the traditional whole-body (whBIS) with respect to continuous assessment of fluid volume status in hemodialysis patients. Twenty patients divided into two groups, hemodynamically stable and unstable, were recruited. Bioimpedance data from two different electrodes configurations (hand-to-foot and knee-to-knee) were collected and retrospectively analysed. A good correlation between the two methods with respect to changes in extracellular resistance (Re) and Re normalized for ultrafiltration volume (ΔRe/UFV) with p < 0.001 was observed. The relationship between relative change (%) in ΔRe and that in patient weight was most notable with kkBIS (4.82 ± 3.31 %/kg) in comparison to whBIS (3.69 ± 2.90 %/kg) in unstable patients. Furthermore, results based on kkBIS showed a reduced ability of the thigh compartments to keep up with the volume changes in the trunk for unstable patients. kkBIS provided a comparable sensitivity to whBIS even in patients at risk of intradialytic hypotension while avoiding the need for the complex implementation imposed by whBIS or other configurations.
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Affiliation(s)
- Abdul Hamid Ismail
- Chair for Medical Information Technology, Helmholtz Institute, RWTH Aachen University, Pauwelsstr. 20, Aachen, Germany
| | - Georg Schlieper
- Department of Nephrology and Immunology (Medical Clinic II), RWTH Aachen University Hospital, Pauwelsstr. 30, Aachen, Germany
| | - Marian Walter
- Chair for Medical Information Technology, Helmholtz Institute, RWTH Aachen University, Pauwelsstr. 20, Aachen, Germany
| | - Jürgen Floege
- Department of Nephrology and Immunology (Medical Clinic II), RWTH Aachen University Hospital, Pauwelsstr. 30, Aachen, Germany
| | - Steffen Leonhardt
- Chair for Medical Information Technology, Helmholtz Institute, RWTH Aachen University, Pauwelsstr. 20, Aachen, Germany
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Antonelou M, El-Kateb S, Davies N, Davenport A. Changes in serum osmotic pressure following haemodialysis treatments lead to changes in bioimpedance spectroscopy estimates of lean and adipose tissue. Eur J Clin Nutr 2017; 71:564-565. [DOI: 10.1038/ejcn.2016.270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/25/2016] [Accepted: 11/27/2016] [Indexed: 12/12/2022]
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Earthman C, Traughber D, Dobratz J, Howell W. Bioimpedance Spectroscopy for Clinical Assessment of Fluid Distribution and Body Cell Mass. Nutr Clin Pract 2017; 22:389-405. [PMID: 17644693 DOI: 10.1177/0115426507022004389] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Body composition assessment has been used to evaluate clinical interventions in research trials, and has the potential to improve patient care in the clinical setting. Body cell mass (BCM) is an important indicator of nutrition status; however, its measurement in the clinic has been limited. BCM can be estimated by the measurement of intracellular water (ICW). The assessment of extracellular water (ECW) is also important because many clinical populations undergo alterations in fluid distribution, particularly individuals with wasting, those receiving dialysis, and obese individuals. Bioimpedance spectroscopy (BIS) is a unique bioimpedance approach that differs in underlying basis from the more readily recognized single-frequency bioelectrical impedance analysis (SF-BIA) in that it does not require the use of statistically derived, population-specific prediction equations. It has the potential advantage of not only measuring total body water (TBW), as does SF-BIA, but also offering the unique capacity to differentiate between ECW and ICW and, thus, to provide an estimate of BCM. This literature review was conducted to compare available BIS devices to multiple dilution for measuring fluid compartments or BCM in a number of populations. Variable results regarding the ability of BIS to measure absolute volumes, as well as the observation of wide limits of variation, make BIS problematic for individual assessment in the clinic, particularly in populations with abnormal fluid distribution or body geometry. BIS has been found to be more accurate for measuring changes in fluid volumes or BCM, particularly in post-surgical and human immunodeficiency virus (HIV)-infected individuals. It is certainly possible that population-specific adjustments may improve the accuracy of BIS for assessing individuals in the clinical setting; however, additional research and development is needed before the method can be accepted for routine clinical use.
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Affiliation(s)
- Carrie Earthman
- University of Minnesota, 225 Food Science and Nutrition, 1334 Eckles Ave., St. Paul, MN 55108, USA.
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12
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Tangvoraphonkchai K, Davenport A. Do Bioimpedance Measurements of Over-Hydration Accurately Reflect Post-Haemodialysis Weight Changes? Nephron Clin Pract 2016; 133:247-52. [DOI: 10.1159/000447702] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/16/2016] [Indexed: 11/19/2022] Open
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13
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El-Kateb S, Davenport A. Changes in hydration following haemodialysis estimated with bioimpedance spectroscopy. Nephrology (Carlton) 2016; 21:410-5. [DOI: 10.1111/nep.12645] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/11/2015] [Accepted: 10/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Sally El-Kateb
- UCL Centre for Nephrology, Royal Free Hospital; University College London Medical School; London UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital; University College London Medical School; London UK
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14
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Ward LC, Isenring E, Dyer JM, Kagawa M, Essex T. Resistivity coefficients for body composition analysis using bioimpedance spectroscopy: effects of body dominance and mixture theory algorithm. Physiol Meas 2015; 36:1529-49. [PMID: 26034992 DOI: 10.1088/0967-3334/36/7/1529] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Body composition is commonly predicted from bioelectrical impedance spectroscopy using mixture theory algorithms. Mixture theory algorithms require the input of values for the resistivities of intra-and extracellular water of body tissues. Various derivations of these algorithms have been published, individually requiring resistivity values specific for each algorithm. This study determined apparent resistivity values in 85 healthy males and 66 healthy females for each of the four published mixture theory algorithms. The resistivity coefficients determined here are compared to published values and the inter-individual (biological) variation discussed with particular reference to consequential error in prediction of body fluid volumes. In addition, the relationships between the four algorithmic approaches are derived and methods for the inter-conversion of coefficients between algorithms presented.
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Affiliation(s)
- L C Ward
- School Chemistry and Molecular Biosciences, The University of Queensland, Australia
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15
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Matthie JR. Bioimpedance measurements of human body composition: critical analysis and outlook. Expert Rev Med Devices 2014; 5:239-61. [DOI: 10.1586/17434440.5.2.239] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Aspromonte N, Cruz DN, Ronco C, Valle R. Role of Bioimpedance Vectorial Analysis in Cardio-Renal Syndromes. Semin Nephrol 2012; 32:93-9. [DOI: 10.1016/j.semnephrol.2011.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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A novel bioimpedance technique to monitor fluid volume state during hemodialysis treatment. ASAIO J 2010; 56:215-20. [PMID: 20404719 DOI: 10.1097/mat.0b013e3181d89160] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bioimpedance spectroscopy is a potential candidate for monitoring of body fluids during dialysis. In this article, the suitability of knee-to-knee (KK) as an alternative to wrist-to-ankle (WA) bioimpedance spectroscopy measurements during dialysis is evaluated. Measurements on eight patients (22 dialysis sessions) showed a good correlation between the change in extracellular resistance (Re) in KK and WA measurements. A deeper analysis indicated that the change in Re normalized for ultrafiltrated volume [DeltaRe/UFV (%/L)] depends on the characteristics of the patient: clinically stable patients [with a presumed lower extracellular fluid - total body volume (VB) relationship] show a higher DeltaRe/UFV (%/L) mean +/- standard deviation (WA: 8.90 +/- 1.9 and KK: 8.29 +/- 2.2) than clinically unstable patients with pitting peripheral edema (WA: 2.10 +/- 0.8 and KK: 2.07 +/- 0.2). Simulations based on bioimpedance equations considering Hanai theory confirm the results. The KK method, especially in combination with proper use of the introduced DeltaRe/UFV (%/L) normalization could possibly offer new options for comfortable online monitoring and the evaluation of fluid volume state during dialysis.
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18
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Freiberger M, Brunner P, Mayer M, Surkhi OI, Riu PJ, Scharfetter H. Indicator for hydration balance during haemodialysis based on anisotropic FEM. Physiol Meas 2008; 29:S479-89. [DOI: 10.1088/0967-3334/29/6/s40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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19
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Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gómez J, Lilienthal Heitmann B, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, M W J Schols A, Pichard C. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr 2005; 23:1430-53. [PMID: 15556267 DOI: 10.1016/j.clnu.2004.09.012] [Citation(s) in RCA: 1317] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Accepted: 09/07/2004] [Indexed: 02/06/2023]
Abstract
BIA is easy, non-invasive, relatively inexpensive and can be performed in almost any subject because it is portable. Part II of these ESPEN guidelines reports results for fat-free mass (FFM), body fat (BF), body cell mass (BCM), total body water (TBW), extracellular water (ECW) and intracellular water (ICW) from various studies in healthy and ill subjects. The data suggests that BIA works well in healthy subjects and in patients with stable water and electrolytes balance with a validated BIA equation that is appropriate with regard to age, sex and race. Clinical use of BIA in subjects at extremes of BMI ranges or with abnormal hydration cannot be recommended for routine assessment of patients until further validation has proven for BIA algorithm to be accurate in such conditions. Multi-frequency- and segmental-BIA may have advantages over single-frequency BIA in these conditions, but further validation is necessary. Longitudinal follow-up of body composition by BIA is possible in subjects with BMI 16-34 kg/m(2) without abnormal hydration, but must be interpreted with caution. Further validation of BIA is necessary to understand the mechanisms for the changes observed in acute illness, altered fat/lean mass ratios, extreme heights and body shape abnormalities.
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Affiliation(s)
- Ursula G Kyle
- Clinical Nutrition Unit, Geneva University Hospital, 1211 Geneva 14, Switzerland
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20
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Hoenich NA, Levin NW. Can technology solve the clinical problem of 'dry weight'? Nephrol Dial Transplant 2003; 18:647-50. [PMID: 12637629 DOI: 10.1093/ndt/gfg008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Cox-Reijven PL, Kooman JP, Soeters PB, van der Sande FM, Leunissen KM. Role of bioimpedance spectroscopy in assessment of body water compartments in hemodialysis patients. Am J Kidney Dis 2001; 38:832-8. [PMID: 11576887 DOI: 10.1053/ajkd.2001.27703] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bioimpedance spectroscopy (BIS) has been advocated as a tool to assess fluid status in hemodialysis (HD) patients. However, uncertainty remains about the reliability of BIS in patients with abnormalities in fluid status. Aims of the study are to assess the agreement between total-body water (TBW) and extracellular volume (ECW) measured by BIS and tracer dilution (deuterium oxide [D(2)O] and sodium bromide [NaBr]), the influence of the relative magnitude of water compartments (expressed as TBW(D(2)O) and ECW(NaBr):body weight) on the agreement between BIS and tracer dilution, and the ability of BIS to predict acute changes in fluid status. BIS and tracer dilution techniques were performed in 17 HD patients before a dialysis session. Moreover, the relation between BIS and gravimetric weight changes was assessed during both isolated ultrafiltration and HD. Correlation coefficients between TBW and ECW measured by BIS and tracer dilution were r = 0.71 and r = 0.71, respectively. Mean differences (tracer-BIS) were 6.9 L (limits of agreement, -1.5 to 21.6 L) for TBW and 2.3 L (limits of agreement, -1.7 to 9.7 L) for ECW. There was a significant relationship between the relative magnitude of TBW and ECW compartments and disagreement between BIS and tracer dilution (r = 0.65 and r = 0.77; P < 0.05). During both isolated ultrafiltration and HD, there was a significant relation between gravimetric changes and change in ECW(BIS) (r = 0.83 and r = 0.76; P < 0.05), but not with change in TBW(BIS). In conclusion, agreement between BIS and tracer dilution techniques in the assessment of TBW and ECW in HD patients is unsatisfactory. The discrepancy between BIS and dilution techniques is related to the relative magnitude of body water compartments. Nevertheless, BIS adequately predicted acute changes in ECW during isolated ultrafiltration and HD, in contrast to changes in TBW.
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Affiliation(s)
- P L Cox-Reijven
- Departments of Dietetics, Internal Medicine, and Surgery, University Hospital Maastricht, The Netherlands
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22
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Cox-Reijven PL, Soeters PB. Validation of bio-impedance spectroscopy: effects of degree of obesity and ways of calculating volumes from measured resistance values. Int J Obes (Lond) 2000; 24:271-80. [PMID: 10757619 DOI: 10.1038/sj.ijo.0801123] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Bioelectrical-impedance spectroscopy (BIS) is a very attractive method for body composition measurements in a clinical setting. However, validation studies often yield different results. This can partly be explained by the different approaches used to transform measured resistance values into body compartments. OBJECTIVE The aim of this study was to compare the linear regression (LR) method with the Hanai Mixture theory (HM). Secondly, the effect of degree of overweight on the accuracy of BIS was analysed. DESIGN In 90 people (10 M, 80 F; body mass index (BMI) 23-62 kg/m2) total body water (TBW) and extracellular water (ECW) were measured by deuterium and NaBr dilution methods, respectively, and by BIS. Resistance values of ECW (R(ECW)) and TBW (R(TBW)) were used for volume calculations. Data of half the group were used for LR based on L2/R (L = length, R = resistance) to predict TBW and ECW and to calculate the constants used in the HM (kECW), k(p)). Prediction equations and constants were cross-validated in Group 2. RESULTS Bland and Altman analysis showed that the LR method underestimated TBW by 1.1 l (P < 0.005) and ECW by 1.1 l (P < 0.005). The HM approach underestimated ECW by 0.8 l (P < 0.005). The correlations with the dilution methods and the SEEs for TBW and ECW were comparable for the two approaches. The prediction error of BIS for TBW and ECW correlated with BMI. The constant kECW, and the specific resistivities of the ECW and intracellular water (ICW) pECW and pICW were also correlated with BMI. CONCLUSIONS The mixture approach is slightly more accurate than linear regression, but not sensitive enough for clinical use. The constants used in the HM model are not constants in a population with a wide variation in degree of overweight. The physical causes of the correlation between BMI and constants used in the model should be studied further in order to optimize the mixture model.
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Affiliation(s)
- P L Cox-Reijven
- Department of Dietetics, University Hospital Maastricht, The Netherlands.
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23
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Earthman CP, Matthie JR, Reid PM, Harper IT, Ravussin E, Howell WH. A comparison of bioimpedance methods for detection of body cell mass change in HIV infection. J Appl Physiol (1985) 2000; 88:944-56. [PMID: 10710390 DOI: 10.1152/jappl.2000.88.3.944] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The maintenance of body cell mass (BCM) is critical for survival in human immunodeficiency virus (HIV) infection. Accuracy of bioimpedance for measuring change (Delta) in intracellular water (ICW), which defines BCM, is uncertain. To evaluate bioimpedance-estimated DeltaBCM, the ICW of 21 weight-losing HIV patients was measured before and after anabolic steroid therapy by dilution (total body water by deuterium - extracellular water by bromide) and bioimpedance. Multiple-frequency modeling- and dilution-determined DeltaICW did not differ. The DeltaICW was predicted poorly by 50-kHz parallel reactance, 50-kHz impedance, and 200 - 5-kHz impedance. The DeltaICW predicted by 500 - 5-kHz impedance was closer to, but statistically different from, dilution-determined DeltaICW. However, the effect of random error on the measurement of systematic error in the 500 - 5-kHz method was 12-13% of the average measured DeltaICW; this was nearly twice the percent difference between obtained and threshold statistics. Although the 500 - 5-kHz method cannot be fully rejected, these results support the conclusion that only the multiple-frequency modeling approach accurately monitors DeltaBCM in HIV infection.
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Affiliation(s)
- C P Earthman
- Department of Nutritional Sciences, The University of Arizona, Tucson, Arizona 85721-0038, USA
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Rees AE, Ward LC, Cornish BH, Thomas BJ. Sensitivity of multiple frequency bioelectrical impedance analysis to changes in ion status. Physiol Meas 1999; 20:349-62. [PMID: 10593228 DOI: 10.1088/0967-3334/20/4/302] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bioelectrical impedance analysis has found extensive application as a simple noninvasive method for the assessment of body fluid volumes. The measured impedance is, however, not only related to the volume of fluid but also to its inherent resistivity. The primary determinant of the resistivities of body fluids is the concentration of ions. The aim of this study was to investigate the sensitivity of bioelectrical impedance analysis to bodily ion status. Whole body impedance over a range of frequencies (4-1012 kHz) of rats was measured during infusion of various concentrations of saline into rats concomitant with measurement of total body and intracellular water by tracer dilution techniques. Extracellular resistance (R0), intracellular resistance (R(i)) and impedance at the characteristic frequency (Z(c)) were calculated. R0 and Z(c) were used to predict extracellular and total body water respectively using previously published formulae. The results showed that whilst R0 and Z(c) decreased proportionately to the amount of NaCl infused, R(i) increased only slightly. Impedances at the end of infusion predicted increases in TBW and ECW of approximately 4-6% despite a volume increase of less than 0.5% in TBW due to the volume of fluid infused. These data are discussed in relation to the assumption of constant resistivity in the prediction of fluid volumes from impedance data.
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Affiliation(s)
- A E Rees
- Department of Biochemistry, University of Queensland, Brisbane, Australia
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25
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Jaffrin MY, Fournier C. Comparison of optical, electrical, and centrifugation techniques for haematocrit monitoring of dialysed patients. Med Biol Eng Comput 1999; 37:433-9. [PMID: 10696698 DOI: 10.1007/bf02513326] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Haematocrits were measured as a function of ultrafiltration in a simulated haemodialysis circuit using bovine blood (plasma conductivity 12 mS cm-1) and hypotonic (8.6 mS cm-1) or hypertonic (16 mS cm-1) dialysates as well as in the absence of dialysate. A comparison was made between measurements by light absorption due to haemoglobin, by impedance in the blood line at 5 kHz using Hanai's model of blood conductivity, by conductivity measurements of blood samples at 1.2 kHz using a conductimeter, by centrifugation of blood samples and by calculations using fluid conservation. The validity of Hanai's model was verified to be satisfactory by direct blood and plasma conductivity measurements. In the absence of ionic transfer the impedance device underestimated the haematocrit by 5 to 7%. This underestimation reached 18% in the case of hypertonic dialysate, but this effect can be minimised if the haematocrit necessary for calibration is measured by centrifugation after 15 min of dialysate circulation when ionic balance is achieved. It was found that the optical method monitors haemoglobin concentration rather than red cell volume changes and is not affected by osmotic red cell swelling in the case of hypotonic dialysate. It can be concluded that the light absorption technique is both more accurate and more convenient to use than impedance.
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Affiliation(s)
- M Y Jaffrin
- UMR CNRS 6600, Dept of Biological Engineering, Technological University of Compiegne, France.
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26
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Ward LC, Elia M, Cornish BH. Potential errors in the application of mixture theory to multifrequency bioelectrical impedance analysis. Physiol Meas 1998; 19:53-60. [PMID: 9522387 DOI: 10.1088/0967-3334/19/1/005] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Potential errors in the application of mixture theory to the analysis of multiple-frequency bioelectrical impedance data for the determination of body fluid volumes are assessed. Potential sources of error include: conductive length; tissue fluid resistivity; body density; weight and technical errors of measurement. Inclusion of inaccurate estimates of body density and weight introduce errors of typically < +/- 3% but incorrect assumptions regarding conductive length or fluid resistivities may each incur errors of up to 20%.
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Affiliation(s)
- L C Ward
- Department of Biochemistry, University of Queensland, Brisbane, Australia.
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