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de Castro NP, Ramos T, de Carvalho Rondó PH, Ward LC. Determination of resistance at zero and infinite frequencies in bioimpedance spectroscopy for assessment of body composition in babies. Physiol Meas 2024. [PMID: 38604189 DOI: 10.1088/1361-6579/ad3dc0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVE
Bioimpedance spectroscopy (BIS) is a popular technique for the assessment of body composition in children and adults but has not found extensive use in babies and infants. This due primarily to technical difficulties of measurement in these groups. Although improvements in data modelling have, in part, mitigated this issue, the problem continues to yield unacceptably high rates of poor quality data. This study investigated an alternative data modelling procedure obviating issues associated with BIS measurements in babies and infants.
Approach
BIS data are conventionally analysed according to the Cole model describing the impedance response of body tissues to an applied AC current. This approach is susceptible to errors due to capacitive leakage errors of measurement at high frequency. The alternative is to model BIS data based on the resistance-frequency spectrum rather than the reactance-resistance Cole model thereby avoiding capacitive error impacts upon reactance measurements.
Main results
The resistance-frequency approach allowed analysis of 100% of data files obtained from BIS measurements in 72 babies compared to 87% successful analyses with the Cole model. Resistance-frequency modelling error (percentage standard error of the estimate) was half that of the Cole method. Estimated resistances at zero and infinite frequency were used to predict body composition. Resistance-based prediction of fat-free mass (FFM) exhibited a 30% improvement in the two-standard deviation limits of agreement with reference FFM measured by air displacement plethysmography when compared to Cole model-based predictions.
Significance
This study has demonstrated improvement in the analysis of BIS data based on the resistance frequency response rather than conventional Cole modelling. This approach is recommended for use where BIS data are compromised by high frequency capacitive leakage errors such as those obtained in babies and infants.
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Affiliation(s)
| | - Tamiris Ramos
- Nutrition Department, University of Sao Paulo, School of Public Health, Sao Paulo, 05508-900, BRAZIL
| | | | - Leigh C Ward
- Department of Biochemistry, University of Queensland, Brisbane, QLD 4072, Brisbane, QLD 4069, AUSTRALIA
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Sabatino A, Kooman J, Avesani CM, Gregorini M, Bianchi S, Regolisti G, Fiaccadori E. Sarcopenia diagnosed by ultrasound-assessed quadriceps muscle thickness and handgrip strength predicts mortality in patients on hemodialysis. J Nephrol 2024:10.1007/s40620-023-01867-7. [PMID: 38263531 DOI: 10.1007/s40620-023-01867-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Estimation of muscle mass is a pivotal component in the diagnosis of protein-energy wasting and sarcopenia. While bioimpedance spectroscopy is a widely accepted technique for the assessment of lean tissue related to the diagnosis of sarcopenia, to date skeletal muscle ultrasound (US) has not gained full acceptance for this purpose. The aim of this study was to assess the predictive value for mortality of the indexed thickness of the quadriceps vastus intermedius, as measured by US, compared to lean tissue index as estimated by bioimpedance spectroscopy, both combined with handgrip strength in a group of patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (HD). METHODS The cut-off values for low handgrip strength were < 27 kg for males and < 16 kg for females. The cut-off value for low lean tissue index was obtained from an age-matched healthy control group, with low lean tissue index being defined as values below the 10th percentile of the distribution of healthy subjects. The cut-off values for low quadriceps vastus intermedius thickness index were < 3.44 mm/m2 for males and < 3.52 mm/m2 for females. RESULTS Ultrasound and bioimpedance spectroscopy were performed in 99 patients, and handgrip strength was assessed in 64 patients, all on maintenance HD. After a median follow-up of 28 months (interquartile range 19-41 months) 38 patients died. Lean tissue index was not associated with mortality, while low quadriceps vastus intermedius thickness index and low handgrip strength were associated with an increased hazard of death. In the fully adjusted model, only the combination of low handgrip strength and low quadriceps vastus intermedius thickness index was significantly associated with higher mortality. CONCLUSION When combined with low handgrip strength, low quadriceps muscle US outperformed low lean tissue index as assessed by bioimpedance spectroscopy in predicting mortality in a cohort of patients on maintenance HD. Ultrasound may be a useful and convenient technique for the assessment of sarcopenia and protein-energy wasting in this patient population.
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Affiliation(s)
- Alice Sabatino
- UO Nefrologia, Azienda Ospedaliera Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy.
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy.
| | - Jeroen Kooman
- University Hospital Maastricht, Maastricht, The Netherlands
| | - Carla Maria Avesani
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden
| | | | | | - Giuseppe Regolisti
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
- UO Clinica e Immunologia Medica, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
| | - Enrico Fiaccadori
- UO Nefrologia, Azienda Ospedaliera Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
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Schork A, Eberbach ML, Bohnert BN, Wörn M, Heister DJ, Eisinger F, Vogel E, Heyne N, Birkenfeld AL, Artunc F. SGLT2 Inhibitors Decrease Overhydration and Proteasuria in Patients with Chronic Kidney Disease: A Longitudinal Observational Study. Kidney Blood Press Res 2024; 49:124-134. [PMID: 38228104 PMCID: PMC10885839 DOI: 10.1159/000535643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/29/2023] [Indexed: 01/18/2024] Open
Abstract
INTRODUCTION SGLT2 inhibitors are used to reduce the risk of progression of chronic kidney disease (CKD). In patients with type 2 diabetes, they have been found to reduce extracellular volume. Given the high prevalence of extracellular volume expansion and overhydration (OH) in CKD, we investigated whether SGLT2 inhibitors might correct these disturbances in CKD patients. METHODS CKD patients who started treatment with an SGLT2 inhibitor were investigated in this prospective observational study for 6 months. Body composition and fluid status were measured by bioimpedance spectroscopy. In addition, spot urine samples were analyzed for albuminuria, glucosuria, and urinary aprotinin-sensitive serine protease activity. RESULTS Forty-two patients (29% with diabetic/hypertensive CKD, 31% with IgA nephropathy; 88% dapagliflozin 10 mg, 10% dapagliflozin 5 mg, 2% empagliflozin 20 mg; median eGFR 46 mL/min/1.73 m2 and albuminuria 1,911 mg/g creatinine) participated in the study. Median glucosuria increased to 14 (10-19) g/g creatinine. At baseline, patients displayed OH with +0.4 (-0.2 to 2.2) L/1.73 m2, which decreased by 0.5 (0.1-1.2) L/1.73 m2 after 6 months. Decrease of OH correlated with higher OH at BL, decrease of albuminuria, glucosuria, and urinary aprotinin-sensitive protease activity. Adipose tissue mass was not significantly reduced after 6 months. CONCLUSION SGLT2 inhibitors reduce OH in patients with CKD, which is pronounced in the presence of high albuminuria, glucosuria, and urinary aprotinin-sensitive protease activity.
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Affiliation(s)
- Anja Schork
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Marie-Luise Eberbach
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
| | - Bernhard N Bohnert
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Matthias Wörn
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Tübingen, Germany
| | - David J Heister
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Felix Eisinger
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Elisabeth Vogel
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Nils Heyne
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Andreas L Birkenfeld
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Ferruh Artunc
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Tübingen, Germany
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Cihoric M, Kehlet H, Højlund J, Lauritsen ML, Kanstrup K, Foss NB. Bioimpedance spectroscopy fluid analysis in acute high-risk abdominal surgery, a prospective clinician-blinded observational feasibility study. J Clin Monit Comput 2023; 37:619-627. [PMID: 36333575 PMCID: PMC9638275 DOI: 10.1007/s10877-022-00934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
Objective assessment of fluid status in critical surgical care may help optimize perioperative fluid administration and prevent postoperative fluid retention. We evaluated the feasibility of hydration status and fluid distribution assessment by Bioimpedance spectroscopy Analysis (BIA) in patients undergoing acute high-risk abdominal (AHA) surgery. This observational study included 73 patients undergoing AHA surgery. During the observational period (0-120 h), we registered BIA calculated absolute fluid overload (AFO) and relative fluid overload (RFO), defined as AFO/extracellular water ratio, as well as cumulative fluid balance and weight. Based on RFO values, hydration status was classified into three categories: dehydrated (RFO < - 10%), normohydrated (- 10% ≤ RFO ≤ + 15%), overhydrated RFO > 15%. We performed a total of 365 BIA measurements. Preoperative overhydration was found in 16% of patients, increasing to 66% by postoperative day five. The changes in BIA measured AFO correlated with the cumulative fluid balance (r2 = 0.44, p < .001), and change in weight (r2 = 0.55, p < .0001). Perioperative overhydration measured with BIA was associated with worse outcome compared to patients with normo- or dehydration. We have demonstrated the feasibility of obtaining perioperative bedside BIA measurements in patients undergoing AHA surgery. BIA measurements correlated with fluid balance, weight changes, and postoperative clinical complications. BIA-assessed fluid status might add helpful information to guide fluid management in patients undergoing AHA surgery.
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Affiliation(s)
- M Cihoric
- Department of Anaesthesiology and Intensive Care Medicine, Hvidovre University Hospital, Kettegaard allé 30, 2650, Hvidovre, Capital Region of Denmark, Denmark.
| | - H Kehlet
- Section for Surgical Pathophysiology, JMC, Rigshospitalet, Copenhagen, Capital Region of Denmark, Denmark
| | - J Højlund
- Department of Anaesthesiology and Intensive Care Medicine, Hvidovre University Hospital, Kettegaard allé 30, 2650, Hvidovre, Capital Region of Denmark, Denmark
| | - M L Lauritsen
- Gastrounit, Surgical Section, Hvidovre University Hospital, Hvidovre, Capital Region of Denmark, Denmark
| | - K Kanstrup
- Gastrounit, Surgical Section, Hvidovre University Hospital, Hvidovre, Capital Region of Denmark, Denmark
| | - N B Foss
- Department of Anaesthesiology and Intensive Care Medicine, Hvidovre University Hospital, Kettegaard allé 30, 2650, Hvidovre, Capital Region of Denmark, Denmark
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Mouche A, Parmentier C, Fendri F, Herbez-Rea C, Couderc A, Dehoux L, Avramescu M, Kwon T, Hogan J, Delbet JD, Ulinski T. Benefits of BNP/NT-proBNP serum level evaluation for dry weight adjustment in pediatric hemodialysis patients. Pediatr Nephrol 2023; 38:811-8. [PMID: 35758998 DOI: 10.1007/s00467-022-05658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Dry weight (DW) adjustment in children on hemodialysis (HD) can be challenging. It relies on clinical evaluation and additional supports. Our aim was to study the benefits of cardiac biomarker assessment, in addition to the more commonly used technique, bioimpedance spectroscopy (BIS), and clinical signs for DW prescription in pediatric HD patients. METHOD Observational study including 41 children on HD in three pediatric HD centers in the Paris region. During one session, BIS was performed before the session and serum levels of BNP and NT-proBNP were analyzed before and after the session. RESULTS Median pre-dialysis level of BNP was 87 ng/L [24-192] and NT-proBNP 968 ng/L [442-4828]. Cardiac biomarker levels showed positive correlation with the BIS hydration status evaluation (p = 0.004). The most appropriate cutoff for pre-dialysis BNP to detect significant overhydration (OH) was 165 ng/L (sensitivity 0.67, specificity 0.84). Based on the BIS evaluation, only 32% of patients with high blood pressure (BP) had OH, whereas in the normal BP group, 33% had significant OH. CONCLUSIONS DW prescription for children on HD should not only rely on clinical evaluation, particularly BP, but should also include additional helpful parameters. BIS is well-validated in children, but it has limitations in non-cooperative patients, and its cost can limit its use in some settings. Cardiac biomarkers, especially BNP, were well-correlated to hydration status evaluated by BIS, and thus could add valuable information for individual patient management and DW assessment. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Shah C, Asha W, Vicini F. Current Diagnostic Tools for Breast Cancer-Related Lymphedema. Curr Oncol Rep 2023; 25:151-154. [PMID: 36696076 DOI: 10.1007/s11912-023-01357-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW Breast cancer-related lymphedema (BCRL) can have a significant impact on breast cancer survivors quality of life. The purpose of this review is to evaluate diagnostic tools for the assessment of BCRL. RECENT FINDINGS Multiple BCRL diagnostic tools are available, though older diagnostic tools have low sensitivity, limiting the ability for sub-clinical BCRL diagnosis while BIS and perometry have increased sensitivity and the ability to diagnose BCRL sub-clinically. Prospective studies have demonstrated such an approach coupled to early intervention is associated with low rates of chronic BCRL while a recently published randomized trial demonstrated that prospective surveillance with BIS coupled with early intervention reduced rates of chronic BCRL as compared to circumference measurements with compression garments. Prospective and randomized data support the use of prospective surveillance for BCRL. The strongest data available comes from the PREVENT trial and supports prospective BCRL surveillance with bioimpedance spectroscopy coupled to early intervention with a compression sleeve.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, 10201 Carnegie Avenue, Cleveland, OH, 44106, USA.
| | - Wafa Asha
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
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Shah C, Whitworth P, Valente S, Schwarz GS, Kruse M, Kohli M, Brownson K, Lawson L, Dupree B, Vicini FA. Bioimpedance spectroscopy for breast cancer-related lymphedema assessment: clinical practice guidelines. Breast Cancer Res Treat 2023; 198:1-9. [PMID: 36566297 PMCID: PMC9883343 DOI: 10.1007/s10549-022-06850-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Breast cancer-related lymphedema (BCRL) represents a significant concern for patients following breast cancer treatment, and assessment for BCRL represents a key component of survivorship efforts. Growing data has demonstrated the benefits of early detection and treatment of BCRL. Traditional diagnostic modalities are less able to detect reversible subclinical BCRL while newer techniques such as bioimpedance spectroscopy (BIS) have shown the ability to detect subclinical BCRL, allowing for early intervention and low rates of chronic BCRL with level I evidence. We present updated clinical practice guidelines for BIS utilization to assess for BCRL. METHODS AND RESULTS Review of the literature identified a randomized controlled trial and other published data which form the basis for the recommendations made. The final results of the PREVENT trial, with 3-year follow-up, demonstrated an absolute reduction of 11.3% and relative reduction of 59% in chronic BCRL (through utilization of compression garment therapy) with BIS as compared to tape measurement. This is in keeping with real-world data demonstrating the effectiveness of BIS in a prospective surveillance model. For optimal outcomes patients should receive an initial pre-treatment measurement and subsequently be followed at a minimum quarterly for first 3 years then biannually for years 4-5, then annually as appropriate, consistent with previous guidelines; the target for intervention has been changed from a change in L-Dex of 10 to 6.5. The lack of pre-operative measure does not preclude inclusion in the prospective surveillance model of care. CONCLUSION The updated clinical practice guidelines present a standardized approach for a prospective model of care using BIS for BCRL assessment and supported by evidence from a randomized controlled trial as well as real-world data.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH USA
| | | | - Stephanie Valente
- Department of Breast Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH USA
| | - Graham S. Schwarz
- Deparment of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH USA
| | - Megan Kruse
- Department of Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH USA
| | - Manpreet Kohli
- Department of General Surgery, RWJ Barnabas Health, West Long Beach, NJ USA
| | - Kirstyn Brownson
- Department of General Surgery, University of Utah, Salt Lake City, UT USA
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Cheng L, Chang L, Tian R, Zhou J, Luo F, Zhang H. The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis. Ren Fail 2022; 44:1192-1200. [PMID: 35856161 PMCID: PMC9318232 DOI: 10.1080/0886022x.2022.2095287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is becoming increasingly evident that the accurate assessment of fluid
status is critical to ensure optimal care in patients undergoing
hemodialysis (HD). Various fluid parameters, including
overhydration (OH) and overhydration/extracellular water
(OH/ECW%), which can be obtained using a
bioimpedance spectroscopy device have been used to indicate the hydration
status in such patients. This study aimed to explore the effect of these
fluid parameters on cardiovascular events and determine which parameter was
a better predictor of cardiovascular events (CVEs). Methods A total of 227 patients who underwent HD at the Hangzhou Hospital of
Traditional Chinese Medicine were enrolled in this prospective study between
December 2017 and August 2018. Clinical data were collected, and the fluid
status of patients was assessed using a body composition monitor. The
patients were followed up until December 2020. The primary outcomes were
CVEs. The association between fluid parameters and CVEs was analyzed using
Cox proportional hazards models. The areas under the curve
(AUCs) of receiver operating characteristic analysis and
improvement in the global chi-squared value were used to compare the
predictive values of fluid parameters for CVEs. Results During a median follow-up of 31 months, 66 CVEs were recorded. The
patients with a higher absolute hydration index (OH) and a
relative hydration index (OH/ECW%) exhibited an
increased risk of developing CVEs. After adjusting for confounding factors,
both OH [hazard ratio (HR) 1.279 per L, 95%
confidence interval (CI) 1.047–1.562;
p = 0.016] and OH/ECW%
(HR 1.061 per %, 95% CI 1.017–1.108;
p = 0.006) were
independently associated with CVEs. The predictive ability of the absolute
hydration index was superior to the relative hydration index based on AUC
calculations for CVEs. Furthermore, a greater change in
χ2 in predicting CVEs was noted
for the absolute hydration index. Conclusions Both absolute hydration index and relative hydration index were found to be
independent predictors of CVEs in univariate and multivariate analyses.
Furthermore, the absolute hydration index had a better additive predictive
value than the relative hydration index in predicting CVEs.
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Affiliation(s)
- Linghong Cheng
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Liyang Chang
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rongrong Tian
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jianfang Zhou
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fenxia Luo
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hongmei Zhang
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Rush EC, Plank LD, Lubree H, Bhat DS, Ganpule A, Yajnik CS. Gains in body mass and body water in pregnancy and relationships to birth weight of offspring in rural and urban Pune, India. J Nutr Sci 2022; 11:e75. [PMID: 36304819 DOI: 10.1017/jns.2022.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 12/14/2022] Open
Abstract
Maternal size, weight gain in pregnancy, fetal gender, environment and gestational age are known determinants of birth weight. It is not clear which component of maternal weight or gained weight during pregnancy influences birth weight. We evaluated the association of maternal total body water measured by the deuterium dilution technique (TBW-D2O) at 17 and 34 weeks of gestation with birth weight. A secondary aim was to examine the utility of bioimpedance spectroscopy (BIS) to determine total body water (TBW-BIS) in pregnancy. At 17 and 34 weeks of pregnancy, ninety-nine women (fifty-one rural and forty-eight urban) from Pune, India had measurements of body weight, TBW-D2O, TBW-BIS and offspring birth weight. At 17 weeks of gestation, average weights for rural and urban women were 45⋅5 ± 4⋅8 (sd) and 50⋅7 ± 7⋅8 kg (P < 0⋅0001), respectively. Maternal weight gains over the subsequent 17 weeks for rural and urban women were 6⋅0 ± 2⋅2 and 7⋅5 ± 2⋅8 kg (P = 0⋅003) and water gains were 4⋅0 ± 2⋅4 and 4⋅8 ± 2⋅8 kg (P = 0⋅092), respectively. In both rural and urban women, birth weight was positively, and independently, associated with gestation and parity. Only for rural women, between 17 and 34 weeks, was an increase in dry mass (weight minus TBW-D2O) or a decrease in TBW-D2O as a percentage of total weight associated with a higher birth weight. At both 17 and 34 weeks, TBW-BIS increasingly underestimated TBW-D2O as the water space increased. Differences in body composition during pregnancy between rural and urban environments and possible impacts of nutrition transition on maternal body composition and fetal growth were demonstrated.
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Ward LC, Wells JCK, Lyons-Reid J, Tint MT. Individualized body geometry correction factor (K B) for use when predicting body composition from bioimpedance spectroscopy. Physiol Meas 2022; 43. [PMID: 35294931 DOI: 10.1088/1361-6579/ac5e83] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/16/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Prediction of body composition from bioimpedance spectroscopy (BIS) measurements using mixture theory-based biophysical modelling invokes a factor (KB) to account for differing body geometry (or proportions) between individuals. To date, a single constant value is commonly used. The aim of this study was to investigate variation in KB across individuals and to develop a procedure for estimating an individualized KBvalue. APPROACH Publicly available body dimension data, primarily from the garment industry, were used to calculate KBvalues for individuals of varying body sizes across the life-span. The 3-D surface relationship between weight, height and KB, was determined and used to create look-up tables to enable estimation of KBin individuals based on height and weight. The utility of the proposed method was assessed by comparing body composition predictions from BIS using either a constant KBvalue or the individualized value. RESULTS Computed KB values were well fitted to height and weight by a 3-D surface (R2 = 0.988). Body composition was predicted more accurately compared to reference methods when using individualized KBthan a constant value in infants and children but improvement in prediction was less in adults particularly those with high body mass index. SIGNIFICANCE Prediction of body composition from BIS and mixture theory is improved by using an individualized body proportion factor in those of small body habitus, e.g. children. Improvement is small in adults or non-existent in those of large body size. Further improvements may be possible by incorporating a factor to account for trunk size, i.e., waist circumference.
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Affiliation(s)
- Leigh C Ward
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD 4072, Brisbane, 4072, AUSTRALIA
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, University College London, Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, London, London, WC1N1EH, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Jaz Lyons-Reid
- The University of Auckland Liggins Institute, University of Auckland, 85 Park Road,, Grafton, Auckland, Auckland, Auckland, 1023, NEW ZEALAND
| | - Mya Thway Tint
- Agency for Science , Technology and Research (A*STAR), Singapore Institute for Clinical Sciences, #20-10 Fusionopolis Way,, Connexis, North Tower,, Singapore, 138632, SINGAPORE
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Bechard LJ, Earthman CP, Farr B, Ariagno KA, Hoffmann RM, Pham IV, Mehta NM. Feasibility of bioimpedance spectroscopy and long-term functional assessment in critically ill children. Clin Nutr ESPEN 2022; 47:405-9. [PMID: 35063234 DOI: 10.1016/j.clnesp.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Lean body mass loss due to critical illness in childhood could be detrimental to long term outcomes, including functional status and quality of life. We describe the feasibility of body composition assessment by bioimpedance spectroscopy (BIS) in the pediatric intensive care unit (PICU), and functional status and quality of life assessments up to 6 months following admission in a cohort of mechanically ventilated, critically ill children. METHODS We conducted a prospective, observational pilot study in a multidisciplinary PICU. Children aged 1 month to 18 years who required mechanical ventilation, with expected stay in the PICU of at least 5 days were included. We examined the feasibility of consenting, enrolling, and completing baseline and 6-month assessments of BIS variables, Functional Status Scale (FSS), and Pediatric Quality of Life (Peds QL), in eligible patients. RESULTS Of 32 patients approached, 23 (72%) completed baseline assessments [median (IQR) age 3.4 (1.0, 7.8) years, 14 (61%) male]; 6-month assessments were completed in 15 (65%) enrolled patients. Mean (SD) phase angle at study enrollment was 2.95 (0.93) and the impedance ratio was 0.90 (0.03). Phase angle (rs = -0.58, p = 0.03) and impedance ratio (rs = 0.61, p = 0.02) by BIS were significantly correlated with total FSS at PICU discharge. Median total FSS and FSS tech (feeding and respiratory domains of FSS) scores improved from enrollment [16 (13, 26) and 8 (7, 10)] to 6 months [6 (6, 9) and 2 (2, 4), respectively, p < 0.001]. Median Peds QL total, physical summary and psychosocial summary scores were not significantly different between PICU discharge and 6 months after PICU admission. Correlations between the total 6-month FSS and a) phase angle (-0.45, p = 0.197) and b) impedance ratio (0.56, p = 0.096) at PICU discharge were not significant. CONCLUSIONS We have demonstrated the feasibility of obtaining bedside BIS measurements in the PICU, and functional and quality of life assessments remotely following PICU discharge. Body composition and long-term assessment of functional outcomes and quality of life must be incorporated in nutrition trials in critically ill children.
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Petrolo M, Rangelova E, Toilou M, Hammarqvist F. Body composition, muscle function and biochemical values in patients after pancreatic surgery: An observational study. Clin Nutr 2021; 40:4284-4289. [PMID: 33583661 DOI: 10.1016/j.clnu.2021.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND & AIMS The complex nature of pancreatic operation makes it a high-risk and technically demanding major abdominal procedure, resulting in early pathophysiological alterations. This study aims to observe changes in body composition, muscle function and biochemical values in patients during the early postoperative days (PODs) following pancreaticoduodenectomy or total pancreatectomy. METHODS Assessment of body composition by bioimpedance spectroscopy, muscle function by peak expiratory flow rate (PEFR) and maximum handgrip strength (HGS), and biochemical values were measured in patients the day before surgery and on PODs 3, 6 and 9. RESULTS Significant changes occurred among 34 patients on POD 3 in body weight +2.3 (0.8-3.6) kg, total body water +2.8 (1.1-5.9) L, extracellular water +2.5 (1.2-3.7) L, intracellular water +1.1 (-0.4-1.9) L, phase angle -1.0 (-1.2 to -0.7)°, PEFR -250.0 (-407.5 to -125.0) L/m and HGS -4.8 (-7.3 to -3.0) kg, C-reactive protein +78.0 (41.0-102.8) mg/L, haemoglobin -34.5 (-45.8 to -26.0) g/L, albumin -12 (-16.5 to -10.0) g/L. CONCLUSIONS Changes in water distribution, phase angle, initial reduced muscle function and altered biochemical values were observed during the first 9 PODs.
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Affiliation(s)
- Martina Petrolo
- Clinical Nutrition, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
| | - Elena Rangelova
- Clinical Investigation and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden; Department of Upper Abdominal Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Toilou
- Clinical Nutrition, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Folke Hammarqvist
- Department of Trauma and Acute Reparative Medicine, Karolinska University Hospital, CLINTEC, Karolinska Institute, Stockholm, Sweden
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13
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Sutherland A, Wagner JL, Korentager S, Butterworth J, Amin AL, Balanoff CR, Hangge A, Larson KE. Is bioimpedance spectroscopy a useful tool for objectively assessing lymphovenous bypass surgical outcomes in breast cancer-related lymphedema? Breast Cancer Res Treat 2021; 186:1-6. [PMID: 33392840 DOI: 10.1007/s10549-020-06059-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/15/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE We sought to determine if bioimpedance spectroscopy (BIS) measurements can accurately assess changes in breast cancer-related lymphedema (BCRL) in patients undergoing lymphovenous bypass (LVB). METHODS Patients undergoing LVB for BCRL refractory to conservative treatment from 1/2015 to 12/2018 were identified from an IRB-approved prospectively maintained database at a single institution. All breast cancer patients were assessed with baseline BIS measurements prior to any oncologic surgery and serial BIS during follow-up office visits including before and after LVB. Clinicopathologic information, LVB operative details, and pre- and post-LVB operative BIS measurements were collected. Analysis focused on clinically significant BIS change, defined as two standard deviations (SD), and comparing LVB anastomosis to BIS changes. RESULTS During the study timeframe, nine patients underwent LVB for treatment of BCRL. The majority (78%) received radiation, taxane chemotherapy, and underwent axillary dissection. An average of 5.6 LVB anastomoses were performed per patient. The average change in BIS following LVB was a 3SD reduction, indicating a clinically significant change. This improvement was stable over time, with persistent 2SD reduction at 22 months postoperatively. The number of LVB anastomoses performed did not significantly correlate with the degree of BIS change. CONCLUSIONS This is the first study to utilize BIS measurements to assess response to LVB surgical intervention for BCRL. BIS measurements demonstrated clinically significant improvement after LVB, providing objective evidence in support of this surgical treatment for BCRL. BIS changes should be reported as key objective data in future studies assessing BCRL interventions, including response to LVB.
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Affiliation(s)
- Amanda Sutherland
- Division of Breast Surgery, Department of Surgery, University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS, 66160, USA
| | - Jamie L Wagner
- Division of Breast Surgery, Department of Surgery, University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS, 66160, USA
| | - Sabrina Korentager
- Division of Breast Surgery, Department of Surgery, University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS, 66160, USA
| | - James Butterworth
- Department of Plastic Surgery, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Amanda L Amin
- Division of Breast Surgery, Department of Surgery, University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS, 66160, USA
| | - Christa R Balanoff
- Division of Breast Surgery, Department of Surgery, University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS, 66160, USA
| | - Amanda Hangge
- Division of Breast Surgery, Department of Surgery, University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS, 66160, USA
| | - Kelsey E Larson
- Division of Breast Surgery, Department of Surgery, University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS, 66160, USA.
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Furaz Czerpak K, Gruss Vergara E, Barril Cuadrado G, Pérez Fernández E, Benavides N, de la Flor J, Mendez Á, Martín R. Usefulness of ABPM and bioimpedance for the treatment and control of hypertension in patients on chronic haemodialysis. Nefrologia 2021; 41:17-26. [PMID: 36165357 DOI: 10.1016/j.nefroe.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/11/2020] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Hypertension is very common in haemodialysis (HD) patients, and is associated with increased morbidity and mortality rates. The goals of our research were to: 1. Measure blood pressure (BP) during HD sessions; 2. Study BP in between HD sessions with 44-h Ambulatory Blood Pressure Monitoring (ABPM); 3. Evaluate changes in treatment after the ABPM; 4. Perform bioimpedance spectroscopy (BIS) on all patients and, in those hyper-hydrated or hypertensive according to ABPM, assess for changes in BP after adjusting the dry weight; 5. Identify factors associated with average systolic and diastolic BP measured by ABPM. MATERIAL AND METHODS Prospective observational study, which included 100 patients from our dialysis unit. We measured BP before and after the HD sessions for two weeks and then, mid-week, we attached the ABPM device to the patients for 44 h. Before starting the following dialysis session, we performed BIS. A second ABPM was performed on hyper-hydrated patients and patients hypertensive according to ABPM to evaluate changes in BP values. RESULTS According to the ABPM, 65% of patients had daytime BP > 135/85 mmHg, 90% night-time BP > 120/70 mmHg and 76% average BP > 130/80 mmHg; 11% had a dipper pattern, 51% non-dipper and 38% riser. The average systolic and diastolic BP readings were 4.7 mmHg (3.8%) and 1.1 mmHg (1.64%) higher on the second day. The dose of antihypertensive medication had to be lowered in 6% of patients, 9% had to stop taking it, 28% needed increased doses and 17% had to add a new drug. The pre-HD diastolic BP best matched the ABPM. After performing the bioimpedance and adjusting dry weight, there was a statistically significant decrease in all BP values. The univariate analysis showed that the average systolic BP was higher in patients with a high-calcium dialysis bath, more antihypertensive drugs and higher doses of EPO. The multivariate analysis showed significant association for EPO and number of drugs (p < 0.01). The average diastolic BP was higher in younger patients and patients with lower Charlson index, lower body mass index and less diuresis, those on higher doses of EPO and non-diabetics. The linear regression study showed age (p < 0.005), body mass index (p < 0.03) and EPO (p < 0.03) as significant variables. CONCLUSIONS Our study shows: 1. The variability of hypertension criteria according to use of BP values from during the HD session or ABPM; 2. The variability of BP in the interdialysis period; 3. That the pre-dialysis diastolic BP best corresponds with the ABPM. 4. That the use of both BIS and ABPM improves the control of BP; 5. That the dose of EPO is the most important factor associated with hypertension in our patients.
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Affiliation(s)
- Karina Furaz Czerpak
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, Spain.
| | | | | | - Elia Pérez Fernández
- Departamento de Estadística, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - Nardeth Benavides
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, Spain
| | - José de la Flor
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, Spain
| | - Ángel Mendez
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, Spain
| | - Roberto Martín
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, Spain
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15
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Schork A, Bohnert BN, Heyne N, Birkenfeld AL, Artunc F. Overhydration Measured by Bioimpedance Spectroscopy and Urinary Serine Protease Activity Are Risk Factors for Progression of Chronic Kidney Disease. Kidney Blood Press Res 2020; 45:955-968. [PMID: 33264776 DOI: 10.1159/000510649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Overhydration (OH) is common in chronic kidney disease (CKD) and might be related to the excretion of urinary serine proteases. Progression of CKD is associated with proteinuria; however, the interrelations of urinary serine proteases, OH, and progression of CKD remain unclear. METHODS In n = 179 patients with stable nondialysis-dependent CKD of all stages, OH was measured using bioimpedance spectroscopy (Body Composition Monitor; Fresenius), and urinary serine protease activity was determined using the peptide substrate S-2302. After a median follow-up of 5.9 (IQR: 3.9-6.5) years, progression to end-stage renal disease (ESRD) was analyzed retrospectively. RESULTS OH correlated with baseline MDRD-eGFR, urinary albumin creatinine ratio (ACR), and urinary aprotinin-sensitive serine protease activity. Progression to ESRD occurred in n = 33 patients (19%) and correlated with OH and urinary serine protease activity as well as MDRD-eGFR and ACR. Patients were divided into 2 groups determined by cutoff values from receiver operating characteristics for MDRD-eGFR (32 mL/min/1.73 m2), ACR (43 mg/g creatinine), urinary serine protease activity (0.9 RU/g creatinine), and OH (1 L/1.73 m2). Across these cutoff values, Kaplan-Meier curves for renal survival showed significant separations of the groups. In Cox regression adjusted for MDRD-eGFR, ACR, P-NT-pro-BNP, systolic blood pressure, and diabetes mellitus, patients with OH >1 L/1.73 m2 had a 3.32 (95% CI: 1.26-8.76)-fold higher risk for progression to ESRD. CONCLUSIONS Our results corroborate that OH detected by bioimpedance spectroscopy in CKD patients is an independent risk factor for progression to ESRD in addition to GFR and albuminuria. Urinary serine protease activity is associated with OH and progression of CKD and provides a possible underlying mechanism.
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Affiliation(s)
- Anja Schork
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany, .,Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany, .,German Center for Diabetes Research (DZD), Tübingen, Germany,
| | - Bernhard N Bohnert
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Nils Heyne
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Andreas L Birkenfeld
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Ferruh Artunc
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Tübingen, Germany
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16
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Emran S, Laitinen K, Lappalainen R, Myllymaa S. Novel 3D printing-based probe for impedance spectroscopic examination of oral mucosa: design and preliminary testing with phantom models. J Med Eng Technol 2020; 44:517-526. [PMID: 33135524 DOI: 10.1080/03091902.2020.1831633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The diagnosis of oral potentially malignant disorders currently relies on histopathological examination of surgically removed biopsies causing pain and discomfort for the patient. We hypothesise that non-invasive bioimpedance spectroscopy (BIS) method would overcome these problems and could make possible regular screening of at-risk patients. Previously several hand-made probes have been introduced in such BIS studies. However, for the first time, we aimed to design a 3D printed probe and test it with model samples (saline solutions, cucumber and porcine tongue). We found that it is extremely crucial to select proper printable materials and optimise electrode geometries to avoid electrochemical corrosion problems, short-circuiting and other signal instabilities related to miniaturised probe. However, our final prototype constructed with four high purity silver made electrodes showed a good linearity (R 2 = 0.999) in diluted saline solution measurements over a wide conductivity range (0.25‒8 mS/cm), which covers well the range of values for the different biological tissues. Moreover, our data show that high reproducibility of the manufacturing and measurement is one important merit in the present 3D printed probe. However, further studies are needed to clarify the importance of fixed pressure especially when the tetrapolar 3D printed probe is used as a hand-held apparatus.
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Affiliation(s)
- Shekh Emran
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,SIB Labs, University of Eastern Finland, Kuopio, Finland
| | - Kimmo Laitinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Reijo Lappalainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,SIB Labs, University of Eastern Finland, Kuopio, Finland
| | - Sami Myllymaa
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,SIB Labs, University of Eastern Finland, Kuopio, Finland
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17
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Furaz Czerpak K, Gruss Vergara E, Barril Cuadrado G, Pérez Fernández E, Benavides N, de la Flor J, Mendez Á, Martín R. Usefulness of ABPM and bioimpedance for the treatment and control of hypertension in patients on chronic haemodialysis. Nefrologia 2020; 41:17-26. [PMID: 32950283 DOI: 10.1016/j.nefro.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/31/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Hypertension is very common in haemodialysis (HD) patients, and is associated with increased morbidity and mortality rates. The goals of our research were to: 1. Measure blood pressure (BP) during HD sessions; 2. Study BP in between HD sessions with 44-hour Ambulatory Blood Pressure Monitoring (ABPM); 3. Identify differences between the BP recorded during HD and with the ABPM; 4. Evaluate changes in treatment after the ABPM; 5. Perform bioimpedance spectroscopy (BIS) on all patients and, in those hyper-hydrated or hypertensive according to ABPM, assess for changes in BP after adjusting the dry weight; 6. Identify factors associated with average systolic and diastolic BP measured by ABPM. MATERIAL AND METHODS Prospective observational study, which included 100 patients from our dialysis unit. We measured BP before and after the HD sessions for two weeks and then, mid-week, we attached the ABPM device to the patients for 44 hours. Before starting the following dialysis session, we performed BIS. A second ABPM was performed on hyper-hydrated patients and patients hypertensive according to ABPM to evaluate changes in BP values. RESULTS According to the ABPM, 65% of patients had daytime BP > 135/85 mmHg, 90% night-time BP > 120/70 mmHg and 76% average BP > 130/80 mmHg; 11% had a dipper pattern, 51% non-dipper and 38% riser. The average systolic and diastolic BP readings were 4.7 mmHg (3.8%) and 1.1 mmHg (1.64%) higher on the second day. The dose of antihypertensive medication had to be lowered in 6% of patients, 9% had to stop taking it, 28% needed increased doses and 17% had to add a new drug. The pre-HD diastolic BP best matched the ABPM. After performing the bioimpedance and adjusting dry weight, there was a statistically significant decrease in all BP values. The univariate analysis showed that the average systolic BP was higher in patients with a high-calcium dialysis bath, more antihypertensive drugs and higher doses of EPO. The multivariate analysis showed significant association for EPO and number of drugs (p < 0.01). The average diastolic BP was higher in younger patients and patients with lower Charlson index, lower body mass index and less diuresis, those on higher doses of EPO and non-diabetics. The linear regression study showed age (p < 0.005), body mass index (p < 0.03) and EPO (p < 0.03) as significant variables. CONCLUSIONS Our study shows: 1. The variability of hypertension criteria according to use of BP values from during the HD session or ABPM; 2. The variability of BP in the interdialysis period; 3. That the pre-dialysis diastolic BP best corresponds with the ABPM. 4. That the use of both BIS and ABPM improves the control of BP; 5. That the dose of EPO is the most important factor associated with hypertension in our patients.
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Affiliation(s)
- Karina Furaz Czerpak
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, España.
| | | | | | - Elia Pérez Fernández
- Departamento de Estadística. Hospital Universitario Fundación de Alcorcón, Madrid, España
| | - Nardeth Benavides
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, España
| | - José de la Flor
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, España
| | - Ángel Mendez
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, España
| | - Roberto Martín
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, España
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Matyjek A, Literacki S, Niemczyk S, Rymarz A. Protein energy-wasting associated with nephrotic syndrome - the comparison of metabolic pattern in severe nephrosis to different stages of chronic kidney disease. BMC Nephrol 2020; 21:346. [PMID: 32795277 PMCID: PMC7427894 DOI: 10.1186/s12882-020-02003-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/03/2020] [Indexed: 01/29/2023] Open
Abstract
Background Nephrotic syndrome (NS) is associated with a hypercatabolic state expressed as an exacerbated degradation of muscle mass. However, the clinical significance of this phenomenon has not yet been investigated. The aim of the study was to evaluate the nutritional status of patients with severe NS (defined as nephrotic range proteinuria with hypoalbuminemia ≤2.5 g/dL) and estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m2 in comparison to patients in different stages of chronic kidney disease (CKD). Methods Twenty men with severe NS (NS group) and 40 men without proteinuria similar in term of serum creatinine (control group) were included into the study. A retrospective cohort of 40 men with CKD stage G4 (PreD group) and 20 haemodialysis men (HD group) were added to the analysis after matching for age, height and weight using propensity score matching. The bioimpedance spectroscopy and biochemical nutritional markers were evaluated. Results Nephrotic patients had a significantly lower lean tissue mass (LTM; p = 0.035) and index (a quotient of LTM over height squared, LTI; p = 0.068), with an expected deficiency of LTM by 3.2 kg, and LTI by 0.9 kg/m2 when compared to the control group. A significant lean tissue deficit (defined as LTI below the lower limit of the reference range by 1.0 kg/m2) was observed in 12.5% of patients in the control group in comparison to 31.7% with advanced CKD (PreD+HD; p = 0.032) and 50% with NS (p = 0.003). NS group presented with higher phosphorus (p = 0.029), uric acid (p = 0.002) and blood urea (p = 0.049) than the control group. Blood urea was strongly negatively correlated with LTM in NS (r = − 0.64, p = 0.002). Nine nephrotic patients (45%) were identified as hypercatabolic based on severe hyperphosphatemia (> 5.0 mg/dL) and/or hyperuricemia (> 8.0 mg/dL), and were characterized by higher blood urea and lower prealbumin, as well as LTM lower by 5.6 kg than in less catabolic individuals. Conclusions In term of lean tissue amount, NS group was more similar to advanced CKD than to the control group. We concluded that specific metabolic pattern with elevated phosphorus, uric acid and blood urea, and lean tissue deficiency may be defined as protein-energy wasting associated with nephrotic syndrome (neph-PEW).
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Affiliation(s)
- Anna Matyjek
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Szaserów Street 128, 04-141, Warsaw, Poland.
| | - Slawomir Literacki
- Department of Laboratory Diagnostic, Military Institute of Medicine, Warsaw, Poland
| | - Stanislaw Niemczyk
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Szaserów Street 128, 04-141, Warsaw, Poland
| | - Aleksandra Rymarz
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Szaserów Street 128, 04-141, Warsaw, Poland
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Donahue PMC, Crescenzi R, Lee C, Garza M, Patel NJ, Petersen KJ, Donahue MJ. Magnetic resonance imaging and bioimpedance evaluation of lymphatic abnormalities in patients with breast cancer treatment-related lymphedema. Breast Cancer Res Treat 2020; 183:83-94. [PMID: 32601969 DOI: 10.1007/s10549-020-05765-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/20/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Breast cancer treatment-related lymphedema (BCRL) evaluation is frequently performed using portable measures of limb volume and bioimpedance asymmetry. Here quantitative magnetic resonance imaging (MRI) is applied to evaluate deep and superficial tissue impairment, in both surgical and contralateral quadrants, to test the hypothesis that BCRL impairment is frequently bilateral and extends beyond regions commonly evaluated with portable external devices. METHODS 3-T MRI was applied to investigate BCRL topographical impairment. Female BCRL (n = 33; age = 54.1 ± 11.2 years; stage = 1.5 ± 0.8) and healthy (n = 33; age = 49.4 ± 11.0 years) participants underwent quantitative upper limb MRI relaxometry (T2), bioimpedance asymmetry, arm volume asymmetry, and physical evaluation. Parametric tests were applied to evaluate study measurements (i) between BCRL and healthy participants, (ii) between surgical and contralateral limbs, and (iii) in relation to clinical indicators of disease severity. Two-sided p-value < 0.05 was required for significance. RESULTS Bioimpedance asymmetry was significantly correlated with MRI-measured water relaxation (T2) in superficial tissue. Deep muscle (T2 = 37.6 ± 3.5 ms) and superficial tissue (T2 = 49.8 ± 13.2 ms) relaxation times were symmetric in healthy participants. In the surgical limbs of BCRL participants, deep muscle (T2 = 40.5 ± 4.9 ms) and superficial tissue (T2 = 56.0 ± 14.8 ms) relaxation times were elevated compared to healthy participants, consistent with an edematous micro-environment. This elevation was also observed in contralateral limbs of BCRL participants (deep muscle T2 = 40.3 ± 5.7 ms; superficial T2 = 56.6 ± 13.8 ms). CONCLUSIONS Regional MRI measures substantiate a growing literature speculating that superficial and deep tissue, in surgical and contralateral quadrants, is affected in BCRL. The implications of these findings in the context of titrating treatment regimens and understanding malignancy recurrence are discussed.
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Affiliation(s)
- Paula M C Donahue
- Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Dayani Center for Health and Wellness, Nashville, TN, USA
| | - Rachelle Crescenzi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea Lee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Maria Garza
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niral J Patel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kalen J Petersen
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Wood J, Ward L, Sparrow M, King S. Utility of bioimpedance methods for the assessment of fat-free mass in adult outpatients with inflammatory bowel disease. Nutrition 2020; 77:110833. [PMID: 32450333 DOI: 10.1016/j.nut.2020.110833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Clinically accessible body composition assessment is required to identify fat-free mass (FFM) depletion, which is common in inflammatory bowel disease (IBD) and poorly correlated with body mass index (BMI). The aim of this study was to compare FFM assessed using bioimpedance spectroscopy (BIS) and multifrequency bioelectrical impedance analysis (MFBIA) with dual energy x-ray absorptiometry (DXA) in adult outpatients with IBD. METHODS FFM was measured using DXA, BIS, and MFBIA in 40 outpatients with IBD. Paired t tests, Lin and Pearson's correlations, and limits of agreement (LOA) analysis were used to compare FFMDXA with FFMBIS and FFMMFBIA. RESULTS Participants (26 men, 24 with Crohn's disease) had a median (IQR) age 39 y (32-50 y) and median (IQR) BMI 24.2 kg/m2 (21.9-26.4 kg/m2). Mean FFMDXA was 51.6 ± 12 kg. FFMBIS was highly correlated with FFMDXA (rp = 0.97; P < 0.001); however, BIS significantly overestimated FFM compared with DXA by a mean 3.4 ± 2.6 kg (P < 0.001) and showed wide 95% LOA (-1.7 to 8.4 kg). FFMBIS estimations improved when FFM was adjusted for by BMI using Moissl's predictive algorithm, reducing mean bias to 0.1 ± 2 kg (P = 0.858; 95% LOA -3.9 to 4 kg). The bias between FFMMFBIA and FFMDXA was 1.3 ± 2 kg (P = 0.002) with 95% LOA -2.6 to 5 kg (n = 28). CONCLUSION Unadjusted BIS overestimated FFM in IBD outpatients compared with DXA with poor agreement at an individual level. Adjusting for BMI ameliorated the overestimation. It is suggested for the estimation of FFM in outpatients with IBD that MFBIA or the Moissl algorithm with BIS be used if DXA is unavailable.
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Affiliation(s)
- Jessica Wood
- Nutrition Department, Alfred Hospital, Melbourne VIC, Australia.
| | - Leigh Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, Australia
| | - Miles Sparrow
- Department of Gastroenterology, Alfred Hospital, Melbourne VIC, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, The Alfred Centre, Melbourne VIC, Australia
| | - Susannah King
- Nutrition Department, Alfred Hospital, Melbourne VIC, Australia; Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora VIC, Australia
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21
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Broers NJH, Canaud B, Dekker MJE, van der Sande FM, Stuard S, Wabel P, Kooman JP. Three compartment bioimpedance spectroscopy in the nutritional assessment and the outcome of patients with advanced or end stage kidney disease: What have we learned so far? Hemodial Int 2020; 24:148-161. [PMID: 31970883 PMCID: PMC7216830 DOI: 10.1111/hdi.12812] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 12/15/2022]
Abstract
Bioimpedance spectroscopy (BIS) is an easily applicable tool to assess body composition. The three compartment model BIS (3C BIS) conventionally expresses body composition as lean tissue index (LTI) (lean tissue mass [LTM]/height in meters squared) and fat tissue index (FTI) (adipose tissue mass/height in meters squared), and a virtual compartment reflecting fluid overload (FO). It has been studied extensively in relation to diagnosis and treatment guidance of fluid status disorders in patients with advanced‐stage or end‐stage renal disease. It is the aim of this article to provide a narrative review on the relevance of 3C BIS in the nutritional assessment in this population. At a population level, LTI decreases after the start of hemodialysis, whereas FTI increases. LTI below the 10th percentile is a consistent predictor of outcome whereas a low FTI is predominantly associated with outcome when combined with a low LTI. Recent research also showed the connection between low LTI, inflammation, and FO, which are cumulatively associated with an increased mortality risk. However, studies toward nutritional interventions based on BIS data are still lacking in this population. In conclusion, 3C BIS, by disentangling the components of body mass index, has contributed to our understanding of the relevance of abnormalities in different body compartments in chronic kidney disease patients, and appears to be a valuable prognostic tool, at least at a population level. Studies assessing the effect of BIS guided nutritional intervention could further support its use in the daily clinical care for renal patients.
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Affiliation(s)
- Natascha J H Broers
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Bernard Canaud
- Research and Development, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Marijke J E Dekker
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Frank M van der Sande
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Stefano Stuard
- Research and Development, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Peter Wabel
- Research and Development, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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22
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Abstract
Objectives: Diffuse enlargements of arteriovenous dialysis fistulas customarily attributed to either excessive arterial inflow or central outflow stenosis. The relationship between volume status and clinically enlarged (arteriovenous) fistula (CEF) formation in end-stage renal disease (ESRD) patients is not well understood. Methods: We assessed the pre-dialysis bioimpedance spectroscopy-measured percentage of overhydration (OH%) in 13 prevalent dialysis patients with CEF development and negative angiography and compared the results with those of 52 control dialysis patients (CONTR). All patients were prevalent ESRD patients receiving thrice-weekly maintenance hemodiafiltration at an academic outpatient dialysis unit. Results: 10/13 CEF patients had OH% ≥15% as compared to 20/52 control patients (Chi square p: .02). The degree of OH% was 20.2 ± 7.4% among the CEF vs. 14.4 ± 7.1% in the control group (Student’s t-test p: .01), representing 4.2 ± 3.2 vs. 2.8 ± 1.6 L of excess fluid pre-dialysis (p: .03). Patients with CEF development took an average of 1.7 ± 1.4 vs. 0.8 ± 0.8 (p: .002) antihypertensive medications compared to the CONTR patients, yet their blood pressure was higher: 156/91 vs. 141/78 mmHg (systolic/diastolic p: .03<.0001). We found no difference in fistula vintage, body mass index, age, diabetes status, or diuretic use. The odds ratio of having a CEF in patients with ≥15% OH status was 5.3 (95% CI: 1.3–21.7; p: .01), the Number Needed to Harm with overhydration was 4. Conclusions: There is an association between bioimpedance spectroscopy-measured overhydrated clinical state and the presence of CEF; either as an increased volume capacitance or as a potential cause.
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Affiliation(s)
- Mihály Tapolyai
- a Semmelweis University , Budapest , Hungary.,b Hemodialysis Unit , Fresenius Medical Care , Budapest , Hungary.,c Medical Services , Ralph H. Johnson VA Medical Center , Charleston , SC , USA
| | - Mária Faludi
- a Semmelweis University , Budapest , Hungary.,b Hemodialysis Unit , Fresenius Medical Care , Budapest , Hungary
| | - Klára Berta
- a Semmelweis University , Budapest , Hungary.,b Hemodialysis Unit , Fresenius Medical Care , Budapest , Hungary
| | - Melinda Forró
- d Hemodialysis Unit , Fresenius Medical Care Hungary , Hatvan , Hungary
| | - Lajos Zsom
- e Hemodialysis Unit , Fresenius Medical Care Hungary , Cegléd , Hungary
| | - Ákos G Pethő
- f 1st Department of Internal Medicine, Faculty of Medicine , Semmelweis University , Budapest , Hungary
| | - László Rosivall
- g Department of Pathophysiology, International Nephrology Research and Training Center , Semmelweis University , Budapest , Hungary
| | - Tibor Fülöp
- c Medical Services , Ralph H. Johnson VA Medical Center , Charleston , SC , USA.,h Department of Medicine, Division of Nephrology , Medical University of South Carolina , Charleston , SC , USA
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Nabuco HCG, Tomeleri CM, Sugihara P, Fernandes RR, Cavalcante EF, Dos Santos L, Silva AM, Sardinha LB, Cyrino ES. Effect of whey protein supplementation combined with resistance training on cellular health in pre-conditioned older women: A randomized, double-blind, placebo-controlled trial. Arch Gerontol Geriatr 2019; 82:232-237. [PMID: 30870778 DOI: 10.1016/j.archger.2019.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
AIM The purpose of study was to analyze the effects of a combined whey protein (WP) and RT intervention on cellular health in pre-conditioned older women. METHODS The protocol is a randomized controlled clinical trial with a sample of seventy older women, divided into 3 groups: WP-placebo (WP-PLA, n = 24), placebo-WP (PLA-WP, n = 23), and placebo-placebo (PLA-PLA, n = 23). Each group drank 35 g of product (placebo or WP) pre- and post- training. The RT program was carried out over 12 weeks (3x/week; 3 × 8-12 repetitions maximum). Total body water (TBW), intra (ICW) and extracellular (ECW) water, resistance (R), reactance (Xc), and phase angle (PhA) assessed by bioimpedance spectroscopy. Lean soft tissue (LST) was measured using dual energy X-ray absorptiometry; and food consumption was assessed by means of the average of two 24-hour recalls. ANCOVA for repeated measures was applied for comparisons, with baseline scores used as covariates. RESULTS A group by time interaction (P < 0.05) was observed for LST, ICW and the ECW/ICW ratio. There was a time effect (P < 0.05) for TBW, Xc, and PhA. A reduction (P <0.05) in R was found only in the WP-PLA and PLA-WP groups. CONCLUSION Whey protein supplementation (pre- or post-) combined with RT promoted an increase in ICW and LST, and also a reduction in ECW/ICW ratio in pre-conditioned older women. Regardless of the supplementation intake, the RT regimen improved PhA in older adult women. This trial was registered at ClinicalTrials.gov: NCT03247192.
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Affiliation(s)
- Hellen C G Nabuco
- Federal Institute of Science and Technology of Mato Grosso, Highway BR-364, Km 329, Cuiabá, Mato Grosso, 78106-970, Brazil; Metabolism, Nutrition, and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Highway Celso Garcia Cid, Londrina, Paraná, 86057-970, Brazil.
| | - Crisieli M Tomeleri
- Metabolism, Nutrition, and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Highway Celso Garcia Cid, Londrina, Paraná, 86057-970, Brazil; Faculty of Physical Education, University of Campinas, Érico Veríssimo Avenue, Campinas, São Paulo, 13083-970, Brazil.
| | - Paulo Sugihara
- Metabolism, Nutrition, and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Highway Celso Garcia Cid, Londrina, Paraná, 86057-970, Brazil.
| | - Rodrigo R Fernandes
- Metabolism, Nutrition, and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Highway Celso Garcia Cid, Londrina, Paraná, 86057-970, Brazil.
| | - Edilaine F Cavalcante
- Metabolism, Nutrition, and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Highway Celso Garcia Cid, Londrina, Paraná, 86057-970, Brazil.
| | - Leandro Dos Santos
- Metabolism, Nutrition, and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Highway Celso Garcia Cid, Londrina, Paraná, 86057-970, Brazil.
| | - Analiza M Silva
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, Cruz Quebrada, Dafundo, 1499-002, Portugal.
| | - Luís B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, Cruz Quebrada, Dafundo, 1499-002, Portugal.
| | - Edilson S Cyrino
- Metabolism, Nutrition, and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Highway Celso Garcia Cid, Londrina, Paraná, 86057-970, Brazil.
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Abstract
BACKGROUND Abnormalities in fluid status in hemodialysis (HD) patients are highly prevalent and are related to adverse outcomes. SUMMARY The inherent discontinuity of the HD procedure in combination with an often compromised cardiovascular response is a major contributor to this phenomenon. In addition, systemic inflammation and endothelial dysfunction are related to extracellular fluid overload (FO). Underlying this relation may be factors such as hypoalbuminemia and an increased capillary permeability, leading to an altered fluid distribution between the blood volume (BV) and the interstitial fluid compartments, compromising fluid removal during dialysis. Indeed, whereas estimates of extracellular volume by bioimpedance spectroscopy are highly predictive of mortality, absolute BV assessed by the saline dilution technique was predictive of intra-dialytic morbidity. Changes in relative BV during HD are positively related to ultrafiltration rate (UFR) and, at least in some studies, negatively to FO. High UFR is also related to changes in central venous oxygen saturation (ScvO2), a marker for tissue perfusion. On the one hand, high UFR and more pronounced declines in ScvO2, but on the other hand, flat relative BV curves are also predictive of mortality; the relation between outcome which statics and dynamics of fluid status appears to be complex. Key Message: While technological developments enable the clinician to monitor statics and dynamics of fluid status and hemodynamics during HD in an accessible way, the role of technology-based interventions needs further study.
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Affiliation(s)
- Jeroen P Kooman
- Maastricht University Medical Center, Maastricht, The Netherlands,
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25
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Kuchnia AJ, Yamada Y, Teigen L, Krueger D, Binkley N, Schoeller D. Combination of DXA and BIS body composition measurements is highly correlated with physical function-an approach to improve muscle mass assessment. Arch Osteoporos 2018; 13:97. [PMID: 30218261 DOI: 10.1007/s11657-018-0508-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/15/2018] [Indexed: 02/03/2023]
Abstract
RATIONALE Fluid volume estimates may help predict functional status and thereby improve sarcopenia diagnosis. MAIN RESULT Bioimpedance-derived fluid volume, combined with DXA, improves identification of jump power over traditional measures. SIGNIFICANCE DXA-measured lean mass should be corrected for fluid distribution in older populations; this may be a surrogate of muscle quality. PURPOSE Sarcopenia, the age-related loss of muscle mass and function, negatively impacts functional status, quality of life, and mortality. We aimed to determine if bioimpedance spectroscopy (BIS)-derived estimates of body water compartments can be used in conjunction with dual-energy X-ray absorptiometry (DXA) measures to aid in the prediction of functional status and thereby, ultimately, improve the diagnosis of sarcopenia. METHODS Participants (≥ 70 years) had physical and muscle function tests, DXA, and BIS performed. Using a BMI correction method, intracellular water (ICWc), extracellular water (ECWc), and ECWc to ICWc (E/Ic) ratio was estimated from standard BIS measures. Jump power was assessed using jump mechanography. RESULTS The traditional measure used to diagnose sarcopenia, DXA-derived appendicular lean mass (ALM) corrected for height (ALM/ht2), was the least predictive measure explaining jump power variability (r2 = 0.31, p < 0.0001). The best measure for explaining jump power was a novel variable combining DXA ALM and BIS-derived E/Ic ratio (ALM/(E/Ic); r2 = 0.70, p < 0.0001). ALM/(E/Ic) and ICWc had the highest correlation with jump power and grip strength, specifically jump power (r = 0.84 and r = 0.80, respectively; p < 0.0001). CONCLUSIONS The creation of a novel variable (ALM/(E/Ic)) improved the ability of DXA to predict jump power in an older population. ALM/(E/Ic) substantially outperformed traditional lean mass measures of sarcopenia and could well be an improved diagnostic approach to predict functional status. DXA-measured ALM should be corrected for fluid distribution, i.e., ALM/(E/Ic); this correction may be considered a surrogate of muscle quality.
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Qin ES, Bowen MJ, Chen WF. Diagnostic accuracy of bioimpedance spectroscopy in patients with lymphedema: A retrospective cohort analysis. J Plast Reconstr Aesthet Surg 2018; 71:1041-1050. [PMID: 29650264 DOI: 10.1016/j.bjps.2018.02.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/08/2018] [Accepted: 02/20/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Bioimpedance spectroscopy (BIS) is used by healthcare specialists to diagnose lymphedema. BIS measures limb fluid content by assessing tissue resistance to the flow of electric current. However, there is debate regarding the validity of BIS in diagnosing early lymphedema. Indocyanine green (ICG) lymphography has been established as the most accurate diagnostic modality to date for lymphedema diagnosis. In this retrospective study, we test the sensitivity, specificity, and diagnostic accuracy of BIS in diagnosing lymphedema by referencing its results with ICG lymphography. METHODS Patients presented to the University of Iowa Lymphedema Center from 2015 to 2017 were evaluated with a standardized protocol that included history and physical examination, a validated lymphedema-specific quality-of-life assessment (LYMQOL), circumference -measurement-based index, BIS, and ICG lymphography. Diagnostic accuracy of BIS was assessed using ICG lymphography as a reference test. RESULTS Fifty-eight patients had positive ICG lymphography results, which confirmed the diagnosis of lymphedema. ICG lymphographic findings consistently correlated with clinical examination, LYMQOL evaluation, and lymphedema indices. By contrast, BIS demonstrated a false-negative rate of 36% - 21 out of 58 patients had normal BIS readings, but a positive ICG lymphography result. The 21 false-negative results occurred in patients with early-stage disease. Sensitivity and specificity for BIS were 0.64 and 1, respectively. CONCLUSION BIS carries an excessively high rate of false-negative results to be dependably used as a diagnostic modality for lymphedema. ICG lymphography highly correlates with other tracking modalities, and it remains the most reliable tool for diagnosing lymphedema.
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Affiliation(s)
- Evelyn S Qin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mindy J Bowen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Wei F Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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Liu H, Lu R, Shastri S, Sonderman M, Van Buren PN. Assessing Extracellular Volume in Hemodialysis Patients Using Intradialytic Blood Pressure Slopes. Nephron Clin Pract 2018; 139:120-130. [PMID: 29439257 DOI: 10.1159/000487093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Extracellular volume (ECV) overload is a mortality risk factor in hemodialysis patients, but no standard approach exists to objectively assess this clinically. We aimed to quantify relationships between slopes of repeated intradialytic blood pressure (BP) measurements and ECV. METHODS In a cross-sectional study of 71 hemodialysis patients, we calculated BP slopes from all intradialytic measurements using Gaussian regression. We measured extracellular and total body water (TBW) with bioimpedance spectroscopy. We analyzed unconditional and conditional associations between BP slope and volume metrics with mixed linear models and sensitivity analyses using non-linear intradialytic BP trajectory. RESULTS Mean systolic intradialytic BP slope (IBPS) was -0.06 (0.1) mm Hg/min. Post-dialysis extracellular water (ECW)/weight was the volume metric mostly strongly associated with slope (r = 0.34, p = 0.007 for unconditional analysis; β = 1.45, p = 0.001 for conditional analysis). Among subjects with post-dialysis systolic BP ≥130 mm Hg, the association strengthened (r = 0.40, p = 0.006; β = 1.42, p = 0.003). ECV was more strongly associated with the BP slope than with pre-dialysis, post-dialysis, or delta systolic BP (r = -0.07, 0.19, 0.28; p = 0.6, 0.1, 0.03). In nonlinear models, BP trajectory also had the strongest association with post-dialysis ECW/body weight (p < 0.001). CONCLUSIONS In hypertensive hemodialysis patients, measurements of ECV excess are more strongly associated with IBPSs than with pre-dialysis, post-dialysis, or change in systolic BP. Among varying volume metrics, post-dialysis ECW/weight has the strongest association with these slopes. Determining IBPS is a novel method to optimize clinical assessment of ECV in hemodialysis patients.
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Affiliation(s)
- Hao Liu
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Nephrology, Dallas, Texas, USA
| | - Rong Lu
- University of Texas Southwestern Medical Center, Department of Clinical Sciences, Dallas, Texas, USA
| | - Shani Shastri
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Nephrology, Dallas, Texas, USA
| | - Mark Sonderman
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Nephrology, Dallas, Texas, USA
| | - Peter Noel Van Buren
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Nephrology, Dallas, Texas, USA.,Division of Nephrology, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
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Kaufman DI, Shah C, Vicini FA, Rizzi M. Utilization of bioimpedance spectroscopy in the prevention of chronic breast cancer-related lymphedema. Breast Cancer Res Treat 2017; 166:809-815. [PMID: 28831632 PMCID: PMC5680358 DOI: 10.1007/s10549-017-4451-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/07/2017] [Indexed: 11/30/2022]
Abstract
Background
This analysis was performed to assess the impact of early intervention following prospective surveillance using bioimpedance spectroscopy (BIS) to detect and manage breast cancer-related lymphedema (BCRL). Methods From 8/2010 to 12/2016, 206 consecutive patients were evaluated with BIS. The protocol included pre-operative assessment with L-Dex as well as post-operative assessments at regular intervals. Patients with L-Dex scores >10 from baseline were considered to have subclinical BCRL and were treated with over-the-counter (OTC) compression sleeve for 4 weeks. High-risk patients were defined as undergoing axillary lymph node dissection (ALND), receiving regional nodal irradiation (RNI), or taxane chemotherapy. Chronic BCRL was defined as the need for complex decongestive physiotherapy (CDP). Results Median follow-up was 25.9 months. Overall, 17% of patients had one high-risk feature, 8% two, and 7% had three. 9.8% of patients were diagnosed with subclinical BCRL with highest rates seen following ALND (23 vs. 7%, p = 0.01). Development of subclinical BCRL was associated with ALND and receipt of RNI. At last follow-up, no patients (0%) developed chronic, clinically detectable, BCRL. Subset analysis was performed of the 30 patients undergoing ALND. Median number of nodes removed was 18 and median number of positive nodes was 2. 77% received taxane chemotherapy, 62% axillary RT, and 48% had elevated BMI. Overall, 86% of patients had at least one additional high-risk feature, 70% at least two, and 23% had all three. Seven patients (23%) had abnormally elevated L-Dex scores at some point during follow-up. To date, none has required CDP. Conclusions The results of this study support prospective surveillance utilizing BIS initiated pre-operatively with subsequent post-operative follow-up measurements for the detection of subclinical BCRL. Intervention triggered by subclinical BCRL detection with an elevated L-Dex score was associated with no cases progressing to chronic, clinically detectable BCRL even in very high-risk patients.
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Affiliation(s)
| | - Chirag Shah
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | - Frank A Vicini
- Michigan Healthcare Professionals, 21st Century Oncology, Farmington Hills, MI, USA
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Kenworthy P, Phillips M, Grisbrook TL, Gibson W, Wood FM, Edgar DW. Monitoring wound healing in minor burns-A novel approach. Burns 2017; 44:70-76. [PMID: 28784342 DOI: 10.1016/j.burns.2017.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/01/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Abstract
Assessment of minor burn wound closure is predominately determined by visual inspection and clinical specialist assessment, which remains largely a subjective analysis and results may vary depending on the clinician's experience. Bioimpedance spectroscopy (BIS) is an instrument that has a demonstrated ability to objectively monitor the wound healing process in various patient populations but has not yet been used in acute burn wounds. The aim of the pilot study was to examine whether the BIS technique is a valid measure of wound healing. Localised BIS resistance and phase angle triplicate measures, of minor limb burns, were collected on two serial occasions. Circumference limb measures were taken at the localised burn site to determine a truncated limb volume. Proportional-odds ordered logistic regression analyses determined resistance at zero frequency (R0, indicative of edema) and resistance of total body fluid (Rinf) were significantly associated with healing after adjustment for the influence of surgery. A one unit increase in R0 and Rinf increased the odds of wound healing by 6% and 5% respectively (p<0.01). Phase angle at 50kHz and Ri were not significantly associated with the markers of the wound healing process. Spearman's correlation determined there was a significant association between a healing wound and limb segment volume (ml) (rho -0.30, p<0.01). BIS is a technique, which has the potential to monitor the progress of wound healing.
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Affiliation(s)
- Pippa Kenworthy
- Fiona Wood Foundation, Fiona Stanley Hospital, Perth, Western Australia, Australia; Burns Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia, Australia; School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
| | - Michael Phillips
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Tiffany L Grisbrook
- Fiona Wood Foundation, Fiona Stanley Hospital, Perth, Western Australia, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Fiona M Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, Perth, Western Australia, Australia; Burns Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Dale W Edgar
- Fiona Wood Foundation, Fiona Stanley Hospital, Perth, Western Australia, Australia; Burns Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia, Australia; Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Huan-Sheng C, Yeong-Chang C, Ming-Hsing H, Fan-Lieh T, Chu-Cheng L, Tsai-Kun W, Hung-Ping C, Sze-Hung H, Hsien-Chang C, Chia-Chen L, Chun-Cheng H, Chun-Ting C, Hung-Hsiang L, Chun-Ju L, Paik-Seong L. Application of bioimpedance spectroscopy in Asian dialysis patients (ABISAD-III): a randomized controlled trial for clinical outcomes. Int Urol Nephrol 2016; 48:1897-1909. [PMID: 27620902 DOI: 10.1007/s11255-016-1415-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 09/01/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE Fluid management with body composition monitor based on bioimpedance spectroscopy (BCM-BIS) has been found to be beneficial for dialysis patients. We conducted a study to provide an algorithm for the determination of post-dialysis target weight (PDTW) and to evaluate whether this approach could improve clinical outcomes compared to patients who had PDTW decided clinically. METHODS Two hundred and ninety-eight dialysis patients participated in this 1-year randomized controlled trial. The outcomes were all-cause hospitalization rate, AFO or CV-related events, hypertension and intra-dialysis morbidities. RESULTS 80 % of post-dialysis weight reached the target set with current algorithm. All-cause hospitalization rate was not different. Incidence of acute fluid overload (AFO) or CV-related events was lower in study group. Longitudinal data showed decreased incidence of hypertension, intra-dialysis morbidities and intra-dialysis hypotension. CONCLUSIONS Assessment of PDTW by BCM-BIS with an explicit algorithm decreased AFO or CV-related events, hypertension and intra-dialysis morbidities. Further studies were required to demonstrate possible benefits of hospitalization rate.
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Affiliation(s)
| | | | | | | | - Lin Chu-Cheng
- Dialysis Center, Yuan Lin Ho's Hospital, Changhua, Taiwan
| | - Wu Tsai-Kun
- Department of Nephrology, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec.1, Chungchi Rd., Wuchi Dist., Taichung City, 43503, Taiwan
| | - Chen Hung-Ping
- Department of Nephrology, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec.1, Chungchi Rd., Wuchi Dist., Taichung City, 43503, Taiwan
| | - Hung Sze-Hung
- Dialysis Center, Tseng Han Chi Hospital, Nantou, Taiwan
| | | | | | - Hou Chun-Cheng
- Department of Nephrology, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Cheng Chun-Ting
- Department of Nephrology, Saint Paul's Hospital, Taoyuan, Taiwan
| | | | - Lin Chun-Ju
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Lim Paik-Seong
- Department of Nephrology, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec.1, Chungchi Rd., Wuchi Dist., Taichung City, 43503, Taiwan.
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Cuba-Gyllensten I, Gastelurrutia P, Bonomi AG, Riistama J, Bayes-Genis A, Aarts RM. A method to adapt thoracic impedance based on chest geometry and composition to assess congestion in heart failure patients. Med Eng Phys 2016; 38:S1350-4533(16)30021-2. [PMID: 27150235 DOI: 10.1016/j.medengphy.2016.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 01/18/2016] [Accepted: 03/06/2016] [Indexed: 11/28/2022]
Abstract
Multi-frequency trans-thoracic bioimpedance (TTI) could be used to track fluid changes and congestion of the lungs, however, patient specific characteristics may impact the measurements. We investigated the effects of thoracic geometry and composition on measurements of TTI and developed an equation to calculate a personalized fluid index. Simulations of TTI measurements for varying levels of chest circumference, fat and muscle proportion were used to derive parameters for a model predicting expected values of TTI. This model was then adapted to measurements from a control group of 36 healthy volunteers to predict TTI and lung fluids (fluid index). Twenty heart failure (HF) patients treated for acute HF were then used to compare the changes in the personalized fluid index to symptoms of HF and predicted TTI to measurements at hospital discharge. All the derived body characteristics affected the TTI measurements in healthy volunteers and together the model predicted the measured TTI with 8.9% mean absolute error. In HF patients the estimated TTI correlated well with the discharged TTI (r=0.73,p <0.001) and the personalized fluid index followed changes in symptom levels during treatment. However, 37% (n=7) of the patients were discharged well below the model expected value. Accounting for chest geometry and composition might help in interpreting TTI measurements.
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Affiliation(s)
- Illapha Cuba-Gyllensten
- Department of Chronic Disease Management, Philips Research, Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Paloma Gastelurrutia
- ICREC Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Alberto G Bonomi
- Department of Chronic Disease Management, Philips Research, Eindhoven, the Netherlands
| | - Jarno Riistama
- Department of Chronic Disease Management, Philips Research, Eindhoven, the Netherlands
| | - Antoni Bayes-Genis
- ICREC Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ronald M Aarts
- Department of Chronic Disease Management, Philips Research, Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Martínez Fernández G, Ortega Cerrato A, de la Vara Iniesta L, Oliver Galera E, Gómez Roldán C, Pérez Martínez J. Comparison of bioimpedance spectroscopy and the Watson formula for measuring body volume in patients on peritoneal dialysis. Nefrologia 2015; 36:57-62. [PMID: 26708614 DOI: 10.1016/j.nefro.2015.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 03/15/2015] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Knowing total body volume (V) is crucial in patients on peritoneal dialysis (PD). It is usually calculated by the Watson anthropometric formula, although the use of bioimpedance spectroscopy (BIS) is becoming increasingly widespread. Measuring V with both methods can at times produce quite different results. OBJECTIVE We aimed to identify differences between the 2 forms of measuring volume in a PD unit and determine which clinical factors are associated with these differences. METHODS Ours is an observational study of 74 patients on PD. We measured V using BIS (Vbis) and the Watson formula (Vw); 271 measurements were made with each method. We calculated the difference between Vbis and Vw in each patient and classified them into 2 groups: Difference between volumes ≥10% or <10% Vbis. We assessed the presence of several clinical parameters in our patients. We assessed whether there were any differences between Vbis and Vw (Student t-test). We determined whether there was any association between the difference in volumes and the presence of the clinical parameters analysed (chi square test). RESULTS V was 2.15 l higher measured by the Watson formula than with BIS (P<.01). In 58.67% of the measurements, the difference between Vbis and Vw was ≥10%. Significant differences were found when comparing the presence of difference between volumes and the presence or not of diabetes mellitus (DM) (p=0,03), hypertension (HTN) (p=0,036), hypoalbuminemia (p<0,01), hypoprealbuminemia (p<0,01), low phase angle at 50 Hz (p<0,01), high C reactive protein (p<0,01), obesity (p=0,027), E/I ratio (ratio between extracellular and intracellular water) ≥1 (p<0.01) and residual diuresis (p=0.029). CONCLUSIONS There are significant differences in the V of PD Unit patients when obtained by Watson formula or by BIS. A difference between the measurements is associated with the presence of DM, HTN, hypoalbuminaemia, obesity, malnutrition, inflammation, E/I ratio ≥1 and the absence of residual diuresis.
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Affiliation(s)
| | - Agustín Ortega Cerrato
- Servicio de Nefrología, Complejo Hospitalario y Universitario de Albacete, Albacete, España
| | | | - Eva Oliver Galera
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Albacete, Galera (Albacete), España
| | - Carmen Gómez Roldán
- Servicio de Nefrología, Complejo Hospitalario y Universitario de Albacete, Albacete, España
| | - Juan Pérez Martínez
- Servicio de Nefrología, Complejo Hospitalario y Universitario de Albacete, Albacete, España.
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Smoot B, Cooper BA, Conley Y, Kober K, Levine JD, Mastick J, Topp K, Miaskowski C. Differences in limb volume trajectories after breast cancer treatment. J Cancer Surviv 2016; 10:772-82. [PMID: 26678895 DOI: 10.1007/s11764-015-0507-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/06/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE Approximately 20 % of patients develop lymphedema (LE) following breast cancer (BC) surgery. An evaluation of distinct trajectories of volume change may improve our ability to diagnose LE sooner. The purposes of this study were to identify subgroups of women with distinct trajectories of limb volume changes following BC surgery and to evaluate for phenotypic differences among these classes. METHODS In this prospective longitudinal study, 380 women were enrolled prior to unilateral BC surgery. Upper limb bioimpedance was measured preoperatively and serially for 1 year postoperatively. Resistance ratios (RRs) were calculated. A RR of >1 indicates affected limb volume > unaffected limb volume. Latent class growth analysis (LCGA) was used to identify classes of women with distinct postoperative RR trajectories. Differences among classes were evaluated using analyses of variance and chi-square analyses. RESULTS Three distinct classes were identified as follows: RR <0.95 (37.9 %), RR ~1.00 (46.8 %), and RR >1.05 (15.3 %). Patients in the RR >1.05 class were more likely to have diabetes (p = 0.036), were more likely to have BC on their dominant side (p < 0.001), had higher RR ratios at the preoperative and 1-month assessments (p < 0.001), and were more likely to be diagnosed with LE (p < 0.001). CONCLUSIONS LCGA is a useful analytic technique to identify subgroups of women who may be at higher risk for the development of LE, based on trajectories of limb volume change after BC surgery. IMPLICATIONS FOR CANCER SURVIVORS Assessment of preoperative and 1-month bioimpedance RRs may allow for the earlier identification of patients who are at higher risk for the development of LE.
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Arroyo D, Panizo N, Abad S, Vega A, Rincón A, de José AP, López-Gómez JM. Impact of the Limitations in Fluid Overload Assessment by Bioimpedance Spectroscopy. Perit Dial Int 2015; 35:604. [PMID: 26450488 DOI: 10.3747/pdi.2015.00164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- D Arroyo
- Nephrology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - N Panizo
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - S Abad
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Vega
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Rincón
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A P de José
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J M López-Gómez
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Merhametsiz O, Oguz EG, Yayar O, Bektan B, Canbakan B, Ayli D. Bioimpedance spectroscopy method to determine hypervolemia in maintenance hemodialysis patients. Hippokratia 2015; 19:324-331. [PMID: 27688697 PMCID: PMC5033143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Hypervolemia is a major risk factor for hypertension leading to cardiovascular diseases and also a frequent problem in maintenance hemodialysis (MHD) patients. Fluid overload (FO) can be determined by bioimpedance spectroscopy (BIS) which is a new, practical, and non-invasive method. We tried to determine FO by BIS in MHD patients and find out the relationship between FO and clinical features. MATERIAL AND METHODS We studied 100 MHD patients aged between 20 and 85 years and undergoing hemodialysis three times weekly for minimum one year. By using BIS, we estimated FO and extracellular water (ECW). The patients who exhibited a FO/ECW ratio >15% were considered as FO. RESULTS Twenty-nine (29.0%) patients had a FO/ECW ratio >15%. In the overhydrated group, the mean pre-hemodialysis systolic blood pressure was 153.3 ± 20.0 mmHg and the mean diastolic blood pressure was 89.1 ± 8.5 mmHg. These were significantly higher than in the non-overhydrated group (113.5 ± 14.5 and 71.0 ± 8.8, p <0.001). FO was significantly correlated with systolic and diastolic blood pressures (r =0.63, p <0.001 and r =0.59, p <0.001). The patients were divided into two groups, i.e. those with cardiothoracic index (CTI) of >0.5 and those with CTI of ≤0.5. The median FO/ECW ratio was 0.11 L in the former group and 0.08 L in the latter group with a significant difference (p =0.006). CONCLUSIONS Hypervolemia is associated with high blood pressure and left ventricular hypertrophy that should be treated effectively to prevent cardiovascular diseases in MHD patients. BIS is useful to assess hydration status in MHD patients. Hippokratia 2015; 19 (4): 324-331.
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Affiliation(s)
- O Merhametsiz
- Department of Nephrology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - E G Oguz
- Department of Nephrology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - O Yayar
- Department of Nephrology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - B Bektan
- Department of Internal Medicine, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - B Canbakan
- Department of Nephrology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - D Ayli
- Department of Nephrology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Soran A, Menekse E, Girgis M, DeGore L, Johnson R. Breast cancer-related lymphedema after axillary lymph node dissection: does early postoperative prediction model work? Support Care Cancer 2015; 24:1413-9. [PMID: 26349574 DOI: 10.1007/s00520-015-2933-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Early detection and timely intervention demonstrate the greatest promise of reducing the incidence of late-stage lymphedema in breast cancer patients undergoing axillary lymph node dissection (ALND). A nomogram was developed for predicting the risk of lymphedema (LE) in patients with ALND. This study's aim was to test the early postoperative prediction model for the diagnosis of clinical and subclinical LE after ALND. METHODS Patients requiring ALND were identified preoperatively through our LE program database. Measurements using metered tape with bioimpedance spectroscopy (L-Dex U400) were obtained preoperatively (n = 180) and at 3-6-month intervals postoperatively. The 5-year probability of LE after ALND was calculated using the Cleveland Clinic Risk Calculator. The discrimination of the nomogram was assessed by calculating the area under (AUC) the receiver operating characteristic curve. RESULTS LE was present in 36.1% (n = 65) of 180 patients with ALND. Of these 65 patients, 22 (12.2%) had clinical LE and 43 (23.9%) had subclinical LE. Statistical analyses showed significant differences in BMI and receipt of radiotherapy between patients with and without LE (p = 0.03 and p = 0.01, respectively). AUC was 0.601, 0.614, and 0.600 for the nomogram using any LE, clinical LE, and subclinical LE patients, respectively. CONCLUSIONS The recently created prediction model for the diagnosis of LE in ALND is not accurate in predicting who will develop clinical or subclinical LE. Periodic monitoring of women with ALND is the most effective method to aid in reducing clinical LE incidence through early detection and timely intervention of LE.
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Affiliation(s)
- Atilla Soran
- Division of Surgical Oncology, Department of Surgery, Magee-Womens Hospital of University of Pittsburgh Medical Center, School of Medicine, University of Pittsburgh, 300 Halket St, Ste 2601, Pittsburgh, PA, USA.
| | - Ebru Menekse
- Division of Surgical Oncology, Department of Surgery, Magee-Womens Hospital of University of Pittsburgh Medical Center, School of Medicine, University of Pittsburgh, 300 Halket St, Ste 2601, Pittsburgh, PA, USA
| | - Mark Girgis
- Division of Surgical Oncology, Department of Surgery, Magee-Womens Hospital of University of Pittsburgh Medical Center, School of Medicine, University of Pittsburgh, 300 Halket St, Ste 2601, Pittsburgh, PA, USA
| | - Lori DeGore
- Division of Surgical Oncology, Department of Surgery, Magee-Womens Hospital of University of Pittsburgh Medical Center, School of Medicine, University of Pittsburgh, 300 Halket St, Ste 2601, Pittsburgh, PA, USA
| | - Ronald Johnson
- Division of Surgical Oncology, Department of Surgery, Magee-Womens Hospital of University of Pittsburgh Medical Center, School of Medicine, University of Pittsburgh, 300 Halket St, Ste 2601, Pittsburgh, PA, USA
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Kose SB, Hur E, Magden K, Yildiz G, Colak D, Kucuk E, Toka B, Kucuk H, Yildirim I, Kokturk F, Duman S. Bioimpedance spectroscopy for the differential diagnosis of hyponatremia. Ren Fail 2015; 37:947-50. [PMID: 25915455 DOI: 10.3109/0886022x.2015.1040418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Hyponatremia is classified according to volume status with the help of physical examination, biochemical measures, urine and serum osmolalities, and echocardiography. Bioimpedance spectroscopy (BIS) has been getting popularity for revealing tissue compositions of various patient groups. The aim of this observational study was to investigate the role of BIS for the differential diagnosis of hyponatremia (ClinicalTrials.gov Identifier: NCT01838759). PATIENTS AND METHODS Personal characteristics of age, sex, weight, height, and blood pressure were recorded. Body composition monitor (BCM) was used for hydration status for each individual. Primary outcome was investigated by the accuracy of volume status measured by BIS. STATISTICS Kappa statistic (K) is a measure of agreement between two sources, which is measured on a binary scale (i.e., condition present/absent). K statistic can take values between 0 and 1: poor agreement: K < 0.20, fair agreement: 0.2.0-0.3.9, moderate agreement: 0.40-0.59, substantial: 0.60-0.79, very good agreement: 0.80-1.00. RESULTS Fifty-eight hyponatremia-diagnosed patients, 32 (55.2%) of male with the mean age of 65.2 ± 11 (40-89) years were included. Kappa statistic (K) were very good (K = 0.925) for male (p < 0.00), substantial agreement (K = 0.601) for female (p < 0.002) with the use of BIS for the differential diagnosis of either hypo or hypervolemia in hyponatremic patients compared with gold standard tests which were the combination of echocardiography, serum, and urine osmolality biochemical tests, and physical examination. CONCLUSION Bioimpedance spectroscopy is a practical and an inexpensive method. This is the first study in the literature showing the role of BIS for the determination of the volume status and differential diagnosis of hyponatremia when compared with echocardiography.
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Affiliation(s)
- Sennur Budak Kose
- a Nephrology Clinic, Istanbul Education and Research Hospital , Istanbul , Turkey
| | - Ender Hur
- b Division of Nephrology , Bulent Ecevit University , Zonguldak , Turkey
| | - Kemal Magden
- b Division of Nephrology , Bulent Ecevit University , Zonguldak , Turkey
| | - Gursel Yildiz
- c Nephrology Clinic, Ataturk State Hospital , Zonguldak , Turkey
| | | | | | | | | | - Ibrahim Yildirim
- b Division of Nephrology , Bulent Ecevit University , Zonguldak , Turkey
| | - Furuzan Kokturk
- g Department of Biostatistics , Bulent Ecevit University , Zonguldak , Turkey , and
| | - Soner Duman
- h Department of Internal Medicine , Ege University , Izmir , Turkey
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Abreo AP, Chertow GM, Dalrymple LS, Kaysen GA, Johansen KL. Association of bioimpedance spectroscopy-based volume estimation with postdialysis hypotension in patients receiving hemodialysis. Hemodial Int 2015; 19:536-42. [PMID: 25881673 DOI: 10.1111/hdi.12305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinical examination to determine the dry weight of patients on hemodialysis (HD) has been problematic, with studies showing discordance between physician assessment and objective measures of volume status.We studied the association between predialysis bioimpedance spectroscopy (BIS)-based estimates of fluid overload and postdialysis hypotension in 635 patients in the United States Renal Data System ACTIVE/ADIPOSE (A Cohort study To Investigate the Value of Exercise/Analyses Designed to Investigate the Paradox of Obesity and Survival in ESRD) study receiving HD in 2009-2011. We recorded predialysis and postdialysis weight and blood pressures over 3 consecutive HD sessions and performed BIS before a single session. Using a previously reported method of estimating normohydration weight, we estimated postdialysis fluid overload (FOpost ) in liters. We used logistic regression with extracellular water/total body water (ECW/TBW) or estimated FOpost as the primary predictor and 1 or more postdialysis systolic blood pressures less than 110 mmHg as the dependent variable. Models were adjusted for age, sex, race, ultrafiltration rate per kilogram of body weight, end-stage renal disease vintage, diabetes mellitus, heart failure, and albumin. Higher ECW/TBW was associated with lower odds of postdialysis hypotension (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.15-0.84 per 0.1, P = 0.02). Every liter of FOpost was associated with lower adjusted odds of postdialysis hypotension (OR 0.86, 95% CI 0.79-0.95, P = 0.003). Prospective studies are needed to determine whether this application of BIS could improve current clinical efforts to minimize episodes of postdialysis hypotension without leading to volume overload.
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Affiliation(s)
- Adrian P Abreo
- Division of Nephrology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Lorien S Dalrymple
- Division of Nephrology, University of California Davis, Davis, California, USA
| | - George A Kaysen
- Division of Nephrology, University of California Davis, Davis, California, USA.,Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, California, USA
| | - Kirsten L Johansen
- Division of Nephrology, University of California, San Francisco, California, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA.,Nephrology Section, San Francisco VA Medical Center, San Francisco, California, USA
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Skrabal F, Pichler GP, Gratze G, Holler A. Adding "hemodynamic and fluid leads" to the ECG. Part I: the electrical estimation of BNP, chronic heart failure (CHF) and extracellular fluid (ECF) accumulation. Med Eng Phys 2014; 36:896-904; discussion 896. [PMID: 24793409 DOI: 10.1016/j.medengphy.2014.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 03/12/2014] [Accepted: 03/25/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In primary care the diagnosis of CHF and ECF accumulation is no triviality. We aimed to predict plasma BNP, CHF and ECF accumulation with segmental impedance spectroscopy while using and extending the electrodes of the conventional electrocardiography. METHODS Three combined multiple electrodes were added to the 15 lead ECG for segmental impedance spectroscopy and for measuring the maximal rate of segmental fluid volume change with heart action at the thorax and the legs. The obtained signals were analyzed by partial correlation analyses in comparison with plasma BNP, CHF classes, ejection fraction by echocardiography and cardiac index by double gas re-breathing. 119 subjects (34 healthy volunteers, 50 patients with CHF, NYHA classes II to IV and 35 patients without CHF) were investigated. RESULTS The maximal rate of volume change with heart action at the thorax and at the legs, as well as the ECF/ICF ratio at the legs contribute equally and independently to the prediction of BNP and heart failure in an unknown test sample of 49 patients (multiple r=0.88, p<0.001). The ROC-curve for the predicted plasma BNP>400 pg/ml gave an AUC=0.93. The absence or the presence of heart failure could be predicted correctly by a binomial logistic regression in 92.9 and 87.5% of cases, respectively. CONCLUSION The methodology, which is based on inverse coupling of BNP release and of maximal blood acceleration and on sensitive detection of ECF overload, could enable the diagnosis of CHF with useful sensitivity and specificity while writing a routine-ECG.
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Affiliation(s)
- Falko Skrabal
- Institute for Cardiovascular and Metabolic Medicine, Mariatrosterstrasse 67, A8043 Graz, Austria.
| | - Georg P Pichler
- Institute for Cardiovascular and Metabolic Medicine, Mariatrosterstrasse 67, A8043 Graz, Austria
| | - Gerfried Gratze
- Krankenhaus Barmherzige Brüder, Marschallgasse, Teaching Hospital Medical University Graz, Austria
| | - Albert Holler
- Krankenhaus Barmherzige Brüder, Marschallgasse, Teaching Hospital Medical University Graz, Austria
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Arroyo D, Panizo N, Abad S, Vega A, Rincón A, de José AP, López-Gómez JM. Intraperitoneal fluid overestimates hydration status assessment by bioimpedance spectroscopy. Perit Dial Int 2014; 35:85-9. [PMID: 24584619 DOI: 10.3747/pdi.2013.00187] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Bioimpedance spectroscopy (BIS) is a valuable tool to assess nutrition and volume status in peritoneal dialysis (PD) patients. However, data about the influence of intraperitoneal fluid on body composition measures are conflicting, and there is no clear consensus about whether the abdomen should be drained before the procedure. We designed a comparison study to detect the influence of intra-abdominal fluid on BIS results. METHODS We performed 73 pairs of BIS measurements in 34 stable PD patients, first with the peritoneum filled with a 1.36% glucose dialysate solution and then after the solution was drained. Patients stayed in the supine position for 10 minutes before the BIS procedure, and the electrodes were not moved between measures. Clinical and demographic data were collected, as were analytic parameters of nutrition and volume status. RESULTS Fluid overload is overestimated when BIS is performed with a full abdomen (1.82 ± 1.73 L vs 1.64 ± 1.68 L, p = 0.043). We also found a spurious overestimation in extracellular water (16.40 ± 3.21 L vs 16.24 ± 3.16 L, p < 0.001) and in relative overhydration (8.29% ± 6.96% vs 7.14% ± 6.79%, p = 0.017). No differences in intracellular water or parameters of nutrition were found. We observed negative correlations for the extracellular water overestimation with age (r = -0.245, p = 0.037), serum B-type natriuretic peptide (r = -0.366, p = 0.036), body mass index (r = -0.248, p = 0.035), and lean tissue index (r = -0.427, p = 0.001). The difference in extracellular water correlated only with body mass index (r = -0.259, p = 0.039). We also found that, assessed at 50 KHz, whole-body impedance (-4.52 ± 8.37, p = 0.001) and phase angle (-0.08 ± 0.23 degrees, p = 0.002) were both lower when BIS was performed in patients with a full abdomen. CONCLUSIONS Fluid overload is overestimated by BIS when performed in patients with dialysate in the peritoneum. The observed differences are greater in younger, more poorly nourished, or less overhydrated patients. If more precise results are required, we suggest that the abdomen be drained before BIS is performed.
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Affiliation(s)
- David Arroyo
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nayara Panizo
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Soraya Abad
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Almudena Vega
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Abraham Rincón
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Pérez de José
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan M López-Gómez
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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