Document Detail


Body fluid volume and nutritional status in hemodialysis: vector bioelectric impedance analysis.
MedLine Citation:
PMID:  20353738     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
M A Espinosa Cuevas; G Navarrete Rodriguez; M E Villeda Martinez; X Atilano Carsi; P Miranda Alatriste; T Tostado Guti?rrez; R Correa-Rotter
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical nephrology     Volume:  73     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-31     Completed Date:  2010-05-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  300-8     Citation Subset:  IM    
Affiliation:
Departamento de Nefrolog?a y Metabolismo Mineral, Instituto Nacional de Ciencias M?dicas y Nutrici?n Salvador Zubir?n, Tlalpan, M?xico D.F. angeles.espinosac@quetzal.innsz.mx
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anthropometry
Body Composition / physiology
Body Water / physiology
Electric Impedance / diagnostic use
Female
Humans
Kidney Failure, Chronic / therapy
Male
Middle Aged
Nutrition Assessment
Nutritional Status / physiology*
Protein-Energy Malnutrition / diagnosis*,  etiology*
Renal Dialysis / adverse effects*
Sex Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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