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Stigger K, Ribeiro LR, Cordeiro FM, Böhlke M. Incidence of hospital admissions in bioimpedance-guided fluid management among maintenance hemodialysis patients-Results of a randomized controlled trial. Hemodial Int 2023. [PMID: 37067785 DOI: 10.1111/hdi.13076] [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: 09/10/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Hemodialysis is life-sustaining in kidney failure. However, proper regulation of body fluids depends on an accurate estimate of target weight. This trial aims to compare clinical endpoints between target weight estimation guided by bioimpedance spectroscopy and usual care in hemodialysis patients. METHODS This is an open-label, parallel-group, controlled trial that randomized, through a table of random numbers, adult patients on maintenance hemodialysis to target weight estimation based on monthly clinical evaluation alone or added to evaluation by bioimpedance twice a year. The primary outcome was survival, and the secondary outcomes were the rate of hospital admissions, change in blood pressure (BP), and antihypertensive drugs load. Participants were followed for 2 years. Survival analysis was performed using Kaplan-Meier estimator and Log-rank test, and hospital admissions were analyzed by the incidence-rate ratio. FINDINGS One hundred and ten patients were randomized to the usual care (52) or bioimpedance (58) groups, with a mean age of 57.4 (15.4) years, 64 (58%) males. There was no difference between the groups at baseline. Survival was not significantly different between groups (log-rank test p = 0.68), but the trial was underpowered for this outcome. There was also no difference between the groups in the change in systolic or diastolic BP or in the number of antihypertensive drugs being used. The incidence rate of hospital admissions was 3.1 and 2.1 per person-year in usual care and bioimpedance groups, respectively, with a time-adjusted incidence rate ratio of 1.48 (95% CI: 1.20-1.82, p = 0.0001) and attributable fraction of risk among exposed individuals of 0.32 (95% CI: 0.17-0.45). DISCUSSION The inclusion of bioimpedance data to guide the estimation of target weight in hemodialysis patients had no detectable impact on survival or BP control, but significantly reduced the incidence rate of hospital admissions. The study was registered at ClinicalTrials.gov Identifier: NCT05272800.
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Affiliation(s)
- Kaiane Stigger
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Larissa Ribas Ribeiro
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
- Dialysis and Transplantation Unit, University Hospital São Francisco de Paula, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Fernanda Moraez Cordeiro
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
- Dialysis and Transplantation Unit, University Hospital São Francisco de Paula, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Maristela Böhlke
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
- Dialysis and Transplantation Unit, University Hospital São Francisco de Paula, Universidade Católica de Pelotas, Pelotas, Brazil
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Nieves-Anaya I, Várgas MB, García OP, Biruete A, Kistler B, Atilano-Carsi X. Effect of oral nutritional supplementation combined with impedance vectors for dry weight adjustment on the nutritional status, hydration status and quality of life in patients on chronic hemodialysis: A pilot study. Clin Nutr ESPEN 2023; 54:23-33. [PMID: 36963868 PMCID: PMC10413440 DOI: 10.1016/j.clnesp.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/22/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Protein energy wasting frequently affect hemodialysis patients and contribute to the development of overhydration. The objective of this study was to assess the effect of oral nutritional supplementation (ONS) combined with bioelectrical vector analysis (BIVA) on the nutritional and hydration status and the quality of life (QoL) in hemodialysis (HD) patients. METHODS Thirty-two chronic HD patients were included in a 6-month randomized pilot study. Patients in SUPL group received a simultaneous intervention consisting of a personalized diet, 245 mL/d ONS and dry weight adjustment through BIVA. Patients in CON group received a personalized diet and dry weight adjustment by BIVA. Anthropometrical, biochemical, dietary, QoL, handgrip strength (HGS) and bioimpedance measurements were performed. Malnutrition Inflammation Score (MIS) was applied. RESULTS At the end of the intervention, moderate undernutrition decreased by 43.8% in SUPL group while in CON group, severe undernutrition increased by 13% (p < 0.04 between groups). In the adjusted covariance analysis, SUPL compared to CON group, increased HGS (Δ 2.8 Kg vs Δ -1.8 Kg, p = 0.003), serum albumin (Δ 0.29 g/dL vs Δ -0.03 g/dL, p = 0.04) and serum transferrin (Δ 4.7 mg/dL vs Δ -0.7 mg/dL, p = 0.0007). The increase in QoL was significantly higher in SUPL group. Dry weight was achieved in 100% of patients in SUPL and 95% in CON group. CONCLUSIONS ONS combined with BIVA for dry weight adjustment, improved nutritional status, QoL and achieved dry weight in HD patients.
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Affiliation(s)
- Iris Nieves-Anaya
- Universidad Autónoma de Querétaro, Facultad de Ciencias Naturales, 76230 Querétaro, Mexico.
| | - Mónica B Várgas
- Universidad Autónoma de Querétaro, Facultad de Ciencias Naturales, 76230 Querétaro, Mexico.
| | - Olga P García
- Universidad Autónoma de Querétaro, Facultad de Ciencias Naturales, 76230 Querétaro, Mexico.
| | - Annabel Biruete
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA 46202.
| | - Brandon Kistler
- Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA.
| | - Ximena Atilano-Carsi
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CP14000, Ciudad de México, Mexico.
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Longley R, Keane DF. This study aimed to evaluate IPC and NMES in haemodialysis patients with lower limb oedema. As a secondary objective, it also set out to evaluate the impact of localised fluid (oedema) on BCM measured fluid status. J Ren Care 2022; 49:93-100. [PMID: 35780390 DOI: 10.1111/jorc.12438] [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: 02/18/2022] [Revised: 05/11/2022] [Accepted: 06/02/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The presence of localised oedema can make measurement and removal of excess fluid in haemodialysis challenging. OBJECTIVES To evaluate (i) the effectiveness of intermittent pneumatic compression and neuromuscular electrical stimulation at mobilising oedema and (ii) the impact of localised fluid on bioimpedance measured fluid status. DESIGN A single centre, cross-over study design. Participants were monitored weekly during mid-week dialysis sessions. Four sessions with each of the interventions and no interventions, with washout periods between, were included. PARTICIPANTS Six participants with lower limb oedema and established on haemodialysis for at least 3 months. MEASUREMENTS The effectiveness of mobilising oedema and improving haemodynamic stability was assessed by: reduction in ankle circumference; ultrafiltration volume achieved; blood pressure changes; participant symptoms and achievement of target weight. The impact of localised fluid on bioimpedance measurements was assessed by comparing measurements across affected tissue with measurements avoiding the site of oedema. RESULTS There were no differences in ultrafiltration volumes, achievement of target weight, participant symptoms or reductions in ankle circumference and systolic blood pressure between intermittent pneumatic compression and neuromuscular electrical stimulation sessions compared to control sessions. Measurements of fluid overload with bioimpedance were 1.7 and 1.8 L higher when measuring across oedematous tissue compared to non-oedematous tissue. CONCLUSIONS We were unable to demonstrate improved mobilisation of fluid in the participant's lower limb, though there was a low number of study participants and notable interindividual variation observed. Bioimpedance offers potential for monitoring fluid management in individuals with lower limb oedema but specific protocols are necessary.
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Affiliation(s)
- Ryan Longley
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals Trust, Leeds, England.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, England
| | - David F Keane
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals Trust, Leeds, England.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, England.,Department of Renal Medicine, Leeds Teaching Hospitals Trust, Leeds, England
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4
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Kaltsatou A, Hadjigeorgiou GM, Grigoriou SS, Karatzaferi C, Giannaki CD, Lavdas E, Fotiou D, Kouidi E, Patramani G, Vogiatzi C, Pappas A, Stefanidis I, Sakkas GK. Cardiac autonomic function during intradialytic exercise training. Postgrad Med 2019; 131:539-545. [DOI: 10.1080/00325481.2019.1663707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Antonia Kaltsatou
- Department of Physical Education & Sport Science, University of Thessaly, Trikala, Greece
| | | | - Stefania S. Grigoriou
- Department of Physical Education & Sport Science, University of Thessaly, Trikala, Greece
| | - Christina Karatzaferi
- Department of Physical Education & Sport Science, University of Thessaly, Trikala, Greece
| | | | - Eleftherios Lavdas
- Department of Radiology and Radiotherapy, Technological Educational Institute of Athens, Athens, Greece
| | - Dimitris Fotiou
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Kouidi
- School of Physical Education & Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Aggelos Pappas
- Department of Physical Education & Sport Science, University of Thessaly, Trikala, Greece
| | | | - Giorgos K. Sakkas
- Department of Physical Education & Sport Science, University of Thessaly, Trikala, Greece
- Cardiff Metropolitan University, Cardiff, UK
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Zhu F, Kaysen GA, Sarkar S, Finkelstein FO, Carter M, Levin NW, Hoenich NA. Evaluation of one year of frequent dialysis on fluid load and body composition using calf bioimpedance technique. Physiol Meas 2019; 40:055004. [PMID: 31035269 DOI: 10.1088/1361-6579/ab1d8f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The primary aim of this study was to evaluate the effect of increased frequency of dialysis (FHD) on change in fluid status and body composition using segmental bioimpedance. APPROACH Twelve stable HD patients were switched from 3 times/week to 6 times/week HD (FHD). Systolic blood pressure (SBP), body mass and body mass index (BMI) were measured pre- and post-HD. Calf resistance (R 5) at 5 kHz was measured using a multifrequency bioimpedance device (Hydra 4200). Calf resistivity (ρ = R 5 * area/length), normalized resistivity (CNR = ρ/BMI) and calf extracellular volume (cECV) were calculated. Fat mass was measured by Futrex body composition analyzers (Futrex 6100, Futrex Tech, Inc.). All measurements were performed at baseline (BL) and monthly for up to one year. MAIN RESULTS Nine patients completed one year of FHD. Compared to BL, body weight and cECV decreased, and CNR increased significantly by the first month but did not change thereafter. SBP pre-HD decreased significantly by the end of the first month with further reduction until month 12. Additionally, antihypertensive medication decreased significantly from baseline by month 4 and remained stable from month 6 throughout the rest of the study. The post-HD CNR in five of nine patients reached the range of normal (>18.5 10-2 * Ohm * m3 kg-1 for males and >19.1 10-2 * Ohm * m3 kg-1 for females) after 1 year FHD. In patients who returned to 3 times/week dialysis, CNR decreased significantly in the first week, and this was associated with increases in body weight and SBP. SIGNIFICANCE Reduction of fluid overload with no alteration of body composition was observed in this study. Accordingly, improving fluid status was confirmed by reducing BP and use of antihypertensive drugs together with increase in CNR. Measurement of fluid status by CNR in hemodialysis patients is a new method to quantitatively assess hydration potentially creating a target for volume of fluid removal.
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Affiliation(s)
- Fansan Zhu
- Renal Research Institute, 315 East 62nd Street, New York, NY 10065, United States of America. Author to whom any correspondence should be addressed
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Abstract
PURPOSE OF REVIEW The aim of this article is to present current information on techniques for fluid status assessment in patients with kidney disease. The methods can be broadly categorized into biomarkers, ultrasound, blood volume monitoring, and bioimpedance. RECENT FINDINGS Biomarkers including atrial natriuretic peptide and B-type natriuretic peptide have been shown to provide information about relative changes in fluid status. Ultrasound is applied to measure inferior vena cava indices, pulmonary indicators, and vascular indicators of fluid overload. Relative blood volume monitoring is used to measure change in intravascular fluid during hemodialysis. While in principle appealing, measurement of absolute blood volume has seen limited use to date. Bioimpedance techniques such as vector analysis, whole body, and regional bioimpedance spectroscopy, have shown their ability to estimate fluid status. SUMMARY The interpretation of biomarkers is complicated by the presence of cardiac disease. All ultrasound methods have some correlation with fluid status; however, operator dependency limits their routine use. Bioimpedance methods and relative blood volume monitoring are increasingly used to assess fluid status in patients with acute or chronic kidney disease. Measurement of absolute blood volume holds promise for the future.
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7
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Abbas SR, Thijssen S, Penne EL, Raimann JG, Liu L, Sipahioglu MH, Seibert E, Wang Y, Chen Y, Xiao Q, Levin NW, Kotanko P, Zhu F. Effect of Change in Fluid Status Evaluated by Bioimpedance Techniques on Body Composition in Hemodialysis Patients. J Ren Nutr 2017; 28:183-190. [PMID: 29158062 DOI: 10.1053/j.jrn.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/01/2017] [Accepted: 09/15/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This prospective study uses calf bioimpedance spectroscopy (cBIS) to guide the attainment of dry weight (DWcBIS) 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 DWcBIS. METHODS Target post-HD weight was gradually reduced from baseline (BL) until DWcBIS was achieved. DWcBIS 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. RESULTS Seventy-three patients enrolled and 60 completed the study (55 ± 13 years, 49% male). Twenty-eight patients (25% diabetes) achieved DWcBIS, whereas 32 patients (47% diabetes) did not. Number of treatment measurements were 16 ± 10 and 12 ± 13 studies per patient in the DWcBIS and non-DWcBIS 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-DWcBIS than in the DWcBIS 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. CONCLUSIONS This study shows that decreasing fluid status by gradual reduction of post-HD weight in both DWcBIS and Non-DWcBIS groups did not affect body composition significantly over a period of about 4 weeks.
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Affiliation(s)
| | | | - Erik L Penne
- Research Group, Renal Research Institute, New York; Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Li Liu
- Research Group, Renal Research Institute, New York; Institute of Nephrology, Peking University First Hospital, Beijing, China
| | - Murat H Sipahioglu
- Research Group, Renal Research Institute, New York; Kayseri University Hospital, Kayseri, Turkey
| | - Eric Seibert
- Research Group, Renal Research Institute, New York; Internal Medicine II, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Yuqi Chen
- University of California, Santa Barbara
| | | | - Nathan W Levin
- Research Group, Renal Research Institute, New York; Icahn School of Medicine at Mount Sinai, New York
| | - Peter Kotanko
- Research Group, Renal Research Institute, New York; Icahn School of Medicine at Mount Sinai, New York
| | - Fansan Zhu
- Research Group, Renal Research Institute, New York.
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Keane DF, Baxter P, Lindley E, Moissl U, Pavitt S, Rhodes L, Wieskotten S. The Body Composition Monitor: a flexible tool for routine fluid management across the haemodialysis population. Biomed Phys Eng Express 2017; 3. [PMID: 28824817 DOI: 10.1088/2057-1976/aa6f45] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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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Affiliation(s)
- D F Keane
- Department of Renal Medicine, Leeds Teaching Hospitals Trust, UK.,Leeds Institute for Cardiovascular and Metabolic Medicine, University Of Leeds, UK.,NIHR HTC Devices for Dignity, UK
| | - P Baxter
- Leeds Institute for Cardiovascular and Metabolic Medicine, University Of Leeds, UK
| | - E Lindley
- Department of Renal Medicine, Leeds Teaching Hospitals Trust, UK.,NIHR HTC Devices for Dignity, UK
| | - U Moissl
- Fresenius Medical Care, Bad Homburg, Germany
| | - S Pavitt
- School of Dentistry, University of Leeds, UK
| | - L Rhodes
- Leeds Institute for Cardiovascular and Metabolic Medicine, University Of Leeds, UK
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Bogónez-Franco P, Nescolarde L, McAdams E, Rosell-Ferrer J. Multifrequency right-side, localized and segmental BIA obtained with different bioimpedance analysers. Physiol Meas 2014; 36:85-106. [PMID: 25501588 DOI: 10.1088/0967-3334/36/1/85] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study is to compare two commercial bioimpedance analysers, BioparHom Z-Métrix and Impedimed SFB7, measuring the impedance of three different body segments. The segments measured were 'right-side' (or 'whole-body'), 'segmental right-lower limb' and 'localized longitudinal right-quadriceps'. The comparison was made on electrical models of each segment, including electrode-skin impedance, and in vivo on nine healthy volunteers. Both devices are designed to measure right-side impedances and, in the present study, as the length of the segment investigated decreased, the accuracy of the impedance measured was found to decrease. The accuracy of the devices was calculated via measurements performed on RC networks of known values. It was found that adding electrode-skin contact impedances in the electrical model affected the accuracy by both devices.
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Affiliation(s)
- P Bogónez-Franco
- INSA INL UMR 5270, Bat. Leonard de Vinci, 21 Avenue Jean Capelle, 69621 Villeurbanne Cedex, France
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Khalil SF, Mohktar MS, Ibrahim F. The theory and fundamentals of bioimpedance analysis in clinical status monitoring and diagnosis of diseases. SENSORS 2014; 14:10895-928. [PMID: 24949644 PMCID: PMC4118362 DOI: 10.3390/s140610895] [Citation(s) in RCA: 293] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 12/13/2022]
Abstract
Bioimpedance analysis is a noninvasive, low cost and a commonly used approach for body composition measurements and assessment of clinical condition. There are a variety of methods applied for interpretation of measured bioimpedance data and a wide range of utilizations of bioimpedance in body composition estimation and evaluation of clinical status. This paper reviews the main concepts of bioimpedance measurement techniques including the frequency based, the allocation based, bioimpedance vector analysis and the real time bioimpedance analysis systems. Commonly used prediction equations for body composition assessment and influence of anthropometric measurements, gender, ethnic groups, postures, measurements protocols and electrode artifacts in estimated values are also discussed. In addition, this paper also contributes to the deliberations of bioimpedance analysis assessment of abnormal loss in lean body mass and unbalanced shift in body fluids and to the summary of diagnostic usage in different kinds of conditions such as cardiac, pulmonary, renal, and neural and infection diseases.
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Affiliation(s)
- Sami F Khalil
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Mas S Mohktar
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Fatimah Ibrahim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Ferrario M, Moissl U, Garzotto F, Cruz DN, Clementi A, Brendolan A, Tetta C, Gatti E, Signorini MG, Cerutti S, Ronco C. Effects of fluid overload on heart rate variability in chronic kidney disease patients on hemodialysis. BMC Nephrol 2014; 15:26. [PMID: 24490775 PMCID: PMC3916802 DOI: 10.1186/1471-2369-15-26] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 01/30/2014] [Indexed: 11/23/2022] Open
Abstract
Background While fluid overload (FO) and alterations in the autonomic nervous system (ANS) such as hypersympathetic activity, are known risk factors for cardiovascular morbidity and mortality in patients on chronic hemodialysis (HD), their relationship has not been thoroughly studied. Methods In this observational study involving 69 patients on chronic HD, FO was assessed by whole body bioimpedance measurements before the midweek HD session and ANS activity reflected by Heart Rate Variability (HRV) was measured using 24-hour Holter electrocardiogram recordings starting before the same HD treatment. In total, 13 different HRV indices were analyzed, comprising a mixture of time domain, frequency domain and complexity parameters. A correlation analysis was performed between the HRV indices and hydration status indices. Successively, patients were retrospectively assigned to a high FO (H, FO > 2.5 L) or low FO (L, FO ≤ 2.5 L) group and these were further compared also after stratification by diabetes mellitus. Finally, a small number of patients without diabetes with significant and persistent FO were followed up for 3 months post-study to investigate how normalization of fluid status affects HRV. Results SDANN, VLF, LZC and HF% parameters significantly correlate with FO (correlation coefficients were respectively r = –0.40, r = –0.37, r = –0.28 and r = 0.26, p-value < 0.05). Furthermore, LF% and LF/HF were inversely correlated with hydration status (correlation coefficients were respectively r = –0.31 and r = -0.33, p-value < 0.05). These results indicate an association between FO and reduced HRV, higher parasympathetic activation and reduced sympathetic response to the HD session. Indeed, group H tended to have lower values of SDANN, VLF and LZC, and higher values of HF% than patients in the L group. Finally, there was a trend towards lower LF% measured during the last 30 minutes of HD for the H group versus the L group. Reduction in FO achieved over 3 months by implementation of a strict fluid management plan resulted in an increase of HRV. Conclusions Our results suggest that depressed HRV is associated with fluid overload and that normalization of hydration status is accompanied by improved HRV.
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Affiliation(s)
- Manuela Ferrario
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, P,zza Leonardo da Vinci 32, Milano, Italy.
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