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Bioelectric impedance predicts total body water, blood pressure, and heart rate during hemodialysis in children and adolescents.
J Ren Nutr. 2008 May; 18(3):304-11.JR

Abstract

OBJECTIVE

The purposes of our study were to: (1) assess if changes in the volemic status of children and adolescents over the course of standard dialysis could be observed using bioelectric impedance (BIA); and (2) evaluate whether the variability of blood pressure (systolic blood pressure, SBP; diastolic blood pressure, DBP) and heart rate (HR) could be explained by independent variables from BIA data.

DESIGN

We used a randomized, single-blinded treatment and repeated-measures design.

SETTING

This study took place at the DaVita Children's Dialysis Center (Chicago, IL).

PATIENTS

There were 7 subjects, aged 10 to 16 years.

INTERVENTION

Two identical standard hemodialysis (HD) sessions were completed, with data collected five times during each HD session: pre-HD, intra-HD (hours 1, 2, and 3), and post-HD. Endpoints included total body water (TBW), resistance (R), reactance (Xc), bioimpedance vector |Z|, supine and sitting SBP, DBP, and HR. Standing SBP, DBP, and HR were collected pre-HD and post-HD.

RESULTS

No differences were observed in TBW between HD sessions for all subjects. However, TBW decreased throughout the HD sessions for all subjects (although no significant differences were seen between hour 3 and post-HD). Reactance (representative of extracellular water) correlated with supine, sitting, and standing SBP (r = 0.55, 0.59, and 0.51, respectively; P < or = .008). The bioimpedance vector increased beginning at hour 1 (P < .001), reflective of a decline in tissue hydration over the course of HD.

CONCLUSIONS

Weight gain in end-stage kidney disease patients is largely fluid. Thus, the use of BIA during HD may aid in the prediction of cardiovascular instability before the development of symptoms, because intravascular hypovolemia and hypotension can result from excessive ultrafiltration below the critical dry weight. In addition, BIA explains, in part, the variability of SBP, DBP, and HR during HD. We suggest that our data also demonstrates the delay in mobilization of fluid from the interstitial space for plasma refill, as evidenced by the delayed change in |Z| over HD. Bioelectric impedance is useful for explaining changes in volemic status and, in part, the variability of SBP, DBP, and HR during HD.

Authors+Show Affiliations

Department of Pediatrics, Division of Kidney Diseases, Northwestern University Feinberg Medical School, Children's Memorial Hospital, Chicago, Illinois 60614, USA. e-brooks3@northwestern.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18410888

Citation

Brooks, Ellen R., et al. "Bioelectric Impedance Predicts Total Body Water, Blood Pressure, and Heart Rate During Hemodialysis in Children and Adolescents." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 18, no. 3, 2008, pp. 304-11.
Brooks ER, Fatallah-Shaykh SA, Langman CB, et al. Bioelectric impedance predicts total body water, blood pressure, and heart rate during hemodialysis in children and adolescents. J Ren Nutr. 2008;18(3):304-11.
Brooks, E. R., Fatallah-Shaykh, S. A., Langman, C. B., Wolf, K. M., & Price, H. E. (2008). Bioelectric impedance predicts total body water, blood pressure, and heart rate during hemodialysis in children and adolescents. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 18(3), 304-11. https://doi.org/10.1053/j.jrn.2007.11.008
Brooks ER, et al. Bioelectric Impedance Predicts Total Body Water, Blood Pressure, and Heart Rate During Hemodialysis in Children and Adolescents. J Ren Nutr. 2008;18(3):304-11. PubMed PMID: 18410888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bioelectric impedance predicts total body water, blood pressure, and heart rate during hemodialysis in children and adolescents. AU - Brooks,Ellen R, AU - Fatallah-Shaykh,Sahar A, AU - Langman,Craig B, AU - Wolf,Kristina M, AU - Price,Heather E, PY - 2007/04/10/received PY - 2008/4/16/pubmed PY - 2008/6/12/medline PY - 2008/4/16/entrez SP - 304 EP - 11 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 18 IS - 3 N2 - OBJECTIVE: The purposes of our study were to: (1) assess if changes in the volemic status of children and adolescents over the course of standard dialysis could be observed using bioelectric impedance (BIA); and (2) evaluate whether the variability of blood pressure (systolic blood pressure, SBP; diastolic blood pressure, DBP) and heart rate (HR) could be explained by independent variables from BIA data. DESIGN: We used a randomized, single-blinded treatment and repeated-measures design. SETTING: This study took place at the DaVita Children's Dialysis Center (Chicago, IL). PATIENTS: There were 7 subjects, aged 10 to 16 years. INTERVENTION: Two identical standard hemodialysis (HD) sessions were completed, with data collected five times during each HD session: pre-HD, intra-HD (hours 1, 2, and 3), and post-HD. Endpoints included total body water (TBW), resistance (R), reactance (Xc), bioimpedance vector |Z|, supine and sitting SBP, DBP, and HR. Standing SBP, DBP, and HR were collected pre-HD and post-HD. RESULTS: No differences were observed in TBW between HD sessions for all subjects. However, TBW decreased throughout the HD sessions for all subjects (although no significant differences were seen between hour 3 and post-HD). Reactance (representative of extracellular water) correlated with supine, sitting, and standing SBP (r = 0.55, 0.59, and 0.51, respectively; P < or = .008). The bioimpedance vector increased beginning at hour 1 (P < .001), reflective of a decline in tissue hydration over the course of HD. CONCLUSIONS: Weight gain in end-stage kidney disease patients is largely fluid. Thus, the use of BIA during HD may aid in the prediction of cardiovascular instability before the development of symptoms, because intravascular hypovolemia and hypotension can result from excessive ultrafiltration below the critical dry weight. In addition, BIA explains, in part, the variability of SBP, DBP, and HR during HD. We suggest that our data also demonstrates the delay in mobilization of fluid from the interstitial space for plasma refill, as evidenced by the delayed change in |Z| over HD. Bioelectric impedance is useful for explaining changes in volemic status and, in part, the variability of SBP, DBP, and HR during HD. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/18410888/Bioelectric_impedance_predicts_total_body_water_blood_pressure_and_heart_rate_during_hemodialysis_in_children_and_adolescents_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-2276(07)00272-5 DB - PRIME DP - Unbound Medicine ER -