1
|
Ehlayel AM, Okunowo O, Dutt M, Howarth K, Zemel BS, Poznick L, Morgan X, Denburg MR, Copelovitch L, Back SJ, Otero HJ, Hartung EA. Assessment of fluid removal using ultrasound, bioimpedance and anthropometry in pediatric dialysis: a pilot study. BMC Nephrol 2023; 24:5. [PMID: 36600202 DOI: 10.1186/s12882-022-03012-1] [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: 01/24/2022] [Accepted: 11/18/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Fluid overload is associated with morbidity and mortality in children receiving dialysis. Accurate clinical assessment is difficult, and using deuterium oxide (D2O) to measure total body water (TBW) is impractical. We investigated the use of ultrasound (US), bioimpedance spectroscopy (BIS), and anthropometry to assess fluid removal in children receiving maintenance hemodialysis (HD). METHODS Participants completed US, BIS, and anthropometry immediately before and 1-2 h after HD for up to five sessions. US measured inferior vena cava (IVC) diameter, lung B-lines, muscle elastography, and dermal thickness. BIS measured the volume of extracellular (ECF) and intracellular (ICF) fluid. Anthropometry included mid-upper arm, calf and ankle circumferences, and triceps skinfold thickness. D2O was performed once pre-HD. We assessed the change in study measures pre- versus post-HD, and the correlation of change in study measures with percent change in body weight (%∆BW). We also assessed the agreement between TBW measured by BIS and D2O. RESULTS Eight participants aged 3.4-18.5 years were enrolled. Comparison of pre- and post-HD measures showed significant decrease in IVC diameters, lung B-lines, dermal thickness, BIS %ECF, mid-upper arm circumference, ankle, and calf circumference. Repeated measures correlation showed significant relationships between %∆BW and changes in BIS ECF (rrm =0.51, 95% CI 0.04, 0.80) and calf circumference (rrm=0.80, 95% CI 0.51, 0.92). BIS TBW correlated with D2O TBW but overestimated TBW by 2.2 L (95% LOA, -4.75 to 0.42). CONCLUSION BIS and calf circumference may be helpful to assess changes in fluid status in children receiving maintenance HD. IVC diameter, lung B-lines and dermal thickness are potential candidates for future studies.
Collapse
Affiliation(s)
- Abdulla M Ehlayel
- Division of Nephrology, Children's Hospital of New Orleans, 200 Henry Clay Ave, New Orleans, LA, 70118, USA.
| | - Oluwatimilehin Okunowo
- Data Science & Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Mohini Dutt
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Kathryn Howarth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Laura Poznick
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Xenia Morgan
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Michelle R Denburg
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Lawrence Copelovitch
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Susan J Back
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Hansel J Otero
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Erum A Hartung
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
2
|
Kato M, Shibata M, Asai K, Harada K, Ito I, Tawada H, Nagai K, Taniguchi S. One-year intradialytic leg exercises with resistance bands and fat mass increase in elderly hemodialysis patients: a retrospective study. Ren Replace Ther 2021; 7:21. [PMID: 33968420 PMCID: PMC8097127 DOI: 10.1186/s41100-021-00341-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intradialytic exercises are recommended to be available as a treatment for enhancing physical functioning. However, there have been few reports which evaluated the results of long-term mild intradialytic exercises in elderly patients. The purpose of this study is to investigate the changes in body weight, body composition, and laboratory data in elderly hemodialysis patients after 1-year intradialytic leg exercises with resistance bands. Methods A retrospective study. Twenty-one outpatients, aged 65 or older (mean ± SD, 75.2 ± 5.1 years), received intradialytic leg exercises with resistance bands for a year were analyzed. The values of dry weight, body composition, and laboratory data were collected from the year-ago period, at baseline and 1 year after baseline. Fat and muscle mass were evaluated by using a multi-frequency bioimpedance device. Results Physical performance changed and body weight increased after 1-year resistance band exercises. However, the participants gained fat mass, not muscle mass. Although the changes in biochemical data related to protein intake were equivocal, triglyceride levels increased significantly after 1-year exercises. An elevation in serum creatinine levels was observed, even if solute clearance increased significantly. Conclusions One-year intradialytic leg exercises with resistance bands may have a potential clinical benefit for body mass index even in elderly hemodialysis patients. However, optimal dietary modification is needed to achieve a balanced increase of muscle and fat mass. An increase of serum creatinine levels does not always mean muscle mass hypertrophy. Supplementary Information The online version contains supplementary material available at 10.1186/s41100-021-00341-z.
Collapse
Affiliation(s)
- Masahiro Kato
- Department of Hemodialysis, Koujukai Rehabilitation Hospital, 85 Kouden, Kunotsubo, Kita-Nagoya, Aichi 481-0041 Japan
| | - Masanori Shibata
- Department of Hemodialysis, Koujukai Rehabilitation Hospital, 85 Kouden, Kunotsubo, Kita-Nagoya, Aichi 481-0041 Japan
| | - Kazuaki Asai
- Department of Hemodialysis, Koujukai Rehabilitation Hospital, 85 Kouden, Kunotsubo, Kita-Nagoya, Aichi 481-0041 Japan
| | - Kumi Harada
- Department of Hemodialysis, Koujukai Rehabilitation Hospital, 85 Kouden, Kunotsubo, Kita-Nagoya, Aichi 481-0041 Japan
| | - Isao Ito
- Department of Hemodialysis, Koujukai Rehabilitation Hospital, 85 Kouden, Kunotsubo, Kita-Nagoya, Aichi 481-0041 Japan
| | - Hisae Tawada
- Department of Hemodialysis, Koujukai Rehabilitation Hospital, 85 Kouden, Kunotsubo, Kita-Nagoya, Aichi 481-0041 Japan
| | - Kojiro Nagai
- Department of Nephrology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503 Japan
| | | |
Collapse
|