Knee-to-knee Bioimpedance Measurements to Monitor Changes in Extracellular Fluid in Haemodynamic-unstable Patients During Dialysis

Overview

Journal J Electr Bioimpedance

Specialty Biophysics

Date 2021 Feb 15

PMID 33584883

Citations 2

Authors

Abdul Hamid Ismail

Georg Schlieper

Marian Walter

Jurgen Floege

Steffen Leonhardt

Affiliations

Soon will be listed here.

Abstract

The feasibility of bioimpedance spectroscopy (BIS) techniques for monitoring intradialytic changes in body fluids is advancing. The aim of this study was to compare the knee-to-knee (kkBIS) with the traditional whole-body (whBIS) with respect to continuous assessment of fluid volume status in hemodialysis patients. Twenty patients divided into two groups, hemodynamically stable and unstable, were recruited. Bioimpedance data from two different electrodes configurations (hand-to-foot and knee-to-knee) were collected and retrospectively analysed. A good correlation between the two methods with respect to changes in extracellular resistance (R) and R normalized for ultrafiltration volume (ΔR/UFV) with < 0.001 was observed. The relationship between relative change (%) in ΔR and that in patient weight was most notable with kkBIS (4.82 ± 3.31 %/kg) in comparison to whBIS (3.69 ± 2.90 %/kg) in unstable patients. Furthermore, results based on kkBIS showed a reduced ability of the thigh compartments to keep up with the volume changes in the trunk for unstable patients. kkBIS provided a comparable sensitivity to whBIS even in patients at risk of intradialytic hypotension while avoiding the need for the complex implementation imposed by whBIS or other configurations.

Citing Articles

Characteristics of bioimpedance-determined fluid shifts according to intradialytic blood pressure difference.

Kwon Y, Choi H, Oh D Ren Fail. 2021; 43(1):1446-1453.

PMID: 34670477 PMC: 8547813. DOI: 10.1080/0886022X.2021.1988639.

Body Composition Results of Caucasian Young Normal Body Mass Women in the Follicular Proliferative Phase, Measured for the Different Positions of Limbs.

Glabska D, Wojciechowska A, Cackowska K, Guzek D Int J Environ Res Public Health. 2021; 18(19).

PMID: 34639521 PMC: 8508292. DOI: 10.3390/ijerph181910214.

References

Zhu F, Schneditz D, Wang E, Levin N . Dynamics of segmental extracellular volumes during changes in body position by bioimpedance analysis. J Appl Physiol (1985). 1998; 85(2):497-504. DOI: 10.1152/jappl.1998.85.2.497. View

Shulman T, Heidenheim A, Kianfar C, Shulman S, Lindsay R . Preserving central blood volume: changes in body fluid compartments during hemodialysis. ASAIO J. 2001; 47(6):615-8. DOI: 10.1097/00002480-200111000-00009. View

Jain A, Lindsay R . Intra and extra cellular fluid shifts during the inter dialytic period in conventional and daily hemodialysis patients. ASAIO J. 2008; 54(1):100-3. DOI: 10.1097/MAT.0b013e318162c404. View

Moissl U, Wabel P, Chamney P, Bosaeus I, Levin N, Bosy-Westphal A . Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas. 2006; 27(9):921-33. DOI: 10.1088/0967-3334/27/9/012. View

Kuhlmann M, Zhu F, Seibert E, Levin N . Bioimpedance, dry weight and blood pressure control: new methods and consequences. Curr Opin Nephrol Hypertens. 2005; 14(6):543-9. DOI: 10.1097/01.mnh.0000185983.48319.00. View

Zhu F, Kuhlmann M, Kaysen G, Sarkar S, Kaitwatcharachai C, Khilnani R . Segment-specific resistivity improves body fluid volume estimates from bioimpedance spectroscopy in hemodialysis patients. J Appl Physiol (1985). 2005; 100(2):717-24. DOI: 10.1152/japplphysiol.00669.2005. View

Ismail A, True N, Gross T, Eilebrecht B, Walter M, Schlieper G . Usefulness of bioimpedance spectroscopy for detection of hypotensive episode during dialysis. ASAIO J. 2014; 60(5):570-5. DOI: 10.1097/MAT.0000000000000104. View

Heitmann B . Impedance: a valid method in assessment of body composition?. Eur J Clin Nutr. 1994; 48(4):228-40. View

Zhu F, Schneditz D, Levin N . Sum of segmental bioimpedance analysis during ultrafiltration and hemodialysis reduces sensitivity to changes in body position. Kidney Int. 1999; 56(2):692-9. DOI: 10.1046/j.1523-1755.1999.00588.x. View

10.

Fuller N, Elia M . Potential use of bioelectrical impedance of the 'whole body' and of body segments for the assessment of body composition: comparison with densitometry and anthropometry. Eur J Clin Nutr. 1989; 43(11):779-91. View

11.

Scharfetter H, Monif M, Laszlo Z, Lambauer T, Hutten H, Hinghofer-Szalkay H . Effect of postural changes on the reliability of volume estimations from bioimpedance spectroscopy data. Kidney Int. 1997; 51(4):1078-87. DOI: 10.1038/ki.1997.150. View

12.

Cox-Reijven P, Van Kreel B, Soeters P . Bio-electrical impedance spectroscopy: alternatives for the conventional hand-to-foot measurements. Clin Nutr. 2002; 21(2):127-33. DOI: 10.1054/clnu.2001.0521. View

13.

Kraemer M, Rode C, Wizemann V . Detection limit of methods to assess fluid status changes in dialysis patients. Kidney Int. 2006; 69(9):1609-20. DOI: 10.1038/sj.ki.5000286. View

14.

Shoji T, Tsubakihara Y, Fujii M, Imai E . Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Int. 2004; 66(3):1212-20. DOI: 10.1111/j.1523-1755.2004.00812.x. View

15.

Medrano G, Eitner F, Walter M, Leonhardt S . Model-based correction of the influence of body position on continuous segmental and hand-to-foot bioimpedance measurements. Med Biol Eng Comput. 2010; 48(6):531-41. DOI: 10.1007/s11517-010-0602-5. View

16.

Matthie J . Second generation mixture theory equation for estimating intracellular water using bioimpedance spectroscopy. J Appl Physiol (1985). 2005; 99(2):780-1. DOI: 10.1152/japplphysiol.00145.2005. View

17.

Zhu F, Kuhlmann M, Sarkar S, Kaitwatcharachai C, Khilnani R, Leonard E . Adjustment of dry weight in hemodialysis patients using intradialytic continuous multifrequency bioimpedance of the calf. Int J Artif Organs. 2004; 27(2):104-9. DOI: 10.1177/039139880402700205. View

18.

Fenech M, Jaffrin M . Extracellular and intracellular volume variations during postural change measured by segmental and wrist-ankle bioimpedance spectroscopy. IEEE Trans Biomed Eng. 2004; 51(1):166-75. DOI: 10.1109/TBME.2003.820338. View

19.

Carter M, Morris A, Zhu F, Zaluska W, Levin N . Effect of body mass index (BMI) on estimation of extracellular volume (ECV) in hemodialysis (HD) patients using segmental and whole body bioimpedance analysis. Physiol Meas. 2005; 26(2):S93-9. DOI: 10.1088/0967-3334/26/2/009. View

20.

Medrano G, Eitner F, Floege J, Leonhardt S . A novel bioimpedance technique to monitor fluid volume state during hemodialysis treatment. ASAIO J. 2010; 56(3):215-20. DOI: 10.1097/MAT.0b013e3181d89160. View