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Body fluid volume and nutritional status in hemodialysis: vector bioelectric impedance analysis.
Clin Nephrol. 2010 Apr; 73(4):300-8.CN

Abstract

BACKGROUND

Protein-energy malnutrition and hypervolemia are major causes of morbidity and mortality in patients on chronic hemodialysis (CHD). The methods used to evaluate nutritional status and volume status remain controversial. Vector bioelectric impedance analysis (vector- BIA) has recently been developed to assess both nutritional status and tissue hydration. The purpose of the study was to assess the nutritional status and volume status of patients on CHD with conventional nutritional assessment methods and with vector-BIA and then to compare the resulting findings.

METHODS

76 Mexican patients on CHD were studied. Nutritional status and body composition were assessed with anthropometry, biochemical variables, and the modified Bilbrey nutritional index (mBNI), the results were compared with both conventional BIA and vector-BIA.

RESULTS

The BNI was used to determine the number of patients with normal nutritional status (n = 27, 35.5%), and mild (n = 31, 40.8%), moderate (n = 10, 13.2%) and severe malnutrition (n = 8, 10.5%). Patients displayed shorter vectors with smaller phase angles or with an overhydration vectorial pattern before the initiation of their hemodialysis session. There was general improvement to normal hydration status post-dialysis (p < 0.05); however, 28% remained overhydrated as assessed by vector-BIA. The vector-BIA results showed that worse malnutrition status was associated with greater volume overload (p < 0.05). Diabetes mellitus (DM) was associated with shorter vectors with smaller phase angles (a vectorial pattern of overhydration and cachexia) (p < 0.05). Patients with lower serum creatinine presented with shorter vectors and smaller phase angles (vectorial patterns of malnutrition and/or overhydration) (p < 0.05). In women, lower serum albumin (< 3.4 g/dl) correlated with greater overhydration and malnutrition (p < 0.05).

CONCLUSIONS

In this population, the vector-BIA showed that 28% of the population remained overhydrated after their hemodialysis session. Diabetics and those with moderate or severe malnutrition were more overhydrated, which is a condition that may be associated with increased cardiovascular morbidity. Because nutritional and volume status are important factors associated with morbidity and mortality in CHD patients, we focused on optimizing the use of existing methods. Our studies suggest that vector-BIA offers a comprehensive and reliable reproducible means of assessing both volume and masses at the bedside and can complement the traditional methods.

Authors+Show Affiliations

Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México D.F. angeles.espinosac@quetzal.innsz.mxNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20353738

Citation

Espinosa Cuevas, M A., et al. "Body Fluid Volume and Nutritional Status in Hemodialysis: Vector Bioelectric Impedance Analysis." Clinical Nephrology, vol. 73, no. 4, 2010, pp. 300-8.
Espinosa Cuevas MA, Navarrete Rodriguez G, Villeda Martinez ME, et al. Body fluid volume and nutritional status in hemodialysis: vector bioelectric impedance analysis. Clin Nephrol. 2010;73(4):300-8.
Espinosa Cuevas, M. A., Navarrete Rodriguez, G., Villeda Martinez, M. E., Atilano Carsi, X., Miranda Alatriste, P., Tostado Gutiérrez, T., & Correa-Rotter, R. (2010). Body fluid volume and nutritional status in hemodialysis: vector bioelectric impedance analysis. Clinical Nephrology, 73(4), 300-8.
Espinosa Cuevas MA, et al. Body Fluid Volume and Nutritional Status in Hemodialysis: Vector Bioelectric Impedance Analysis. Clin Nephrol. 2010;73(4):300-8. PubMed PMID: 20353738.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Body fluid volume and nutritional status in hemodialysis: vector bioelectric impedance analysis. AU - Espinosa Cuevas,M A, AU - Navarrete Rodriguez,G, AU - Villeda Martinez,M E, AU - Atilano Carsi,X, AU - Miranda Alatriste,P, AU - Tostado Gutiérrez,T, AU - Correa-Rotter,R, PY - 2010/4/1/entrez PY - 2010/4/1/pubmed PY - 2010/5/12/medline SP - 300 EP - 8 JF - Clinical nephrology JO - Clin Nephrol VL - 73 IS - 4 N2 - BACKGROUND: Protein-energy malnutrition and hypervolemia are major causes of morbidity and mortality in patients on chronic hemodialysis (CHD). The methods used to evaluate nutritional status and volume status remain controversial. Vector bioelectric impedance analysis (vector- BIA) has recently been developed to assess both nutritional status and tissue hydration. The purpose of the study was to assess the nutritional status and volume status of patients on CHD with conventional nutritional assessment methods and with vector-BIA and then to compare the resulting findings. METHODS: 76 Mexican patients on CHD were studied. Nutritional status and body composition were assessed with anthropometry, biochemical variables, and the modified Bilbrey nutritional index (mBNI), the results were compared with both conventional BIA and vector-BIA. RESULTS: The BNI was used to determine the number of patients with normal nutritional status (n = 27, 35.5%), and mild (n = 31, 40.8%), moderate (n = 10, 13.2%) and severe malnutrition (n = 8, 10.5%). Patients displayed shorter vectors with smaller phase angles or with an overhydration vectorial pattern before the initiation of their hemodialysis session. There was general improvement to normal hydration status post-dialysis (p < 0.05); however, 28% remained overhydrated as assessed by vector-BIA. The vector-BIA results showed that worse malnutrition status was associated with greater volume overload (p < 0.05). Diabetes mellitus (DM) was associated with shorter vectors with smaller phase angles (a vectorial pattern of overhydration and cachexia) (p < 0.05). Patients with lower serum creatinine presented with shorter vectors and smaller phase angles (vectorial patterns of malnutrition and/or overhydration) (p < 0.05). In women, lower serum albumin (< 3.4 g/dl) correlated with greater overhydration and malnutrition (p < 0.05). CONCLUSIONS: In this population, the vector-BIA showed that 28% of the population remained overhydrated after their hemodialysis session. Diabetics and those with moderate or severe malnutrition were more overhydrated, which is a condition that may be associated with increased cardiovascular morbidity. Because nutritional and volume status are important factors associated with morbidity and mortality in CHD patients, we focused on optimizing the use of existing methods. Our studies suggest that vector-BIA offers a comprehensive and reliable reproducible means of assessing both volume and masses at the bedside and can complement the traditional methods. SN - 0301-0430 UR - https://www.unboundmedicine.com/medline/citation/20353738/Body_fluid_volume_and_nutritional_status_in_hemodialysis:_vector_bioelectric_impedance_analysis_ L2 - http://www.dustri.com/nc/journals-in-english.html?artId=7462 DB - PRIME DP - Unbound Medicine ER -