Bioimpedance and Fluid Status in Children and Adolescents Treated With Dialysis

Gregorio P. Milani, Jaap W. Groothoff, Federica A. Vianello, Emilio F. Fossali, Fabio Paglialonga, Alberto Edefonti, Carlo Agostoni, Dario Consonni, Dewi van Harskamp, Johannes B. van Goudoever, Henk Schierbeek, Michiel J.S. Oosterveld

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background Assessment of hydration status in patients with chronic kidney failure treated by dialysis is crucial for clinical management decisions. Dilution techniques are considered the gold standard for measurement of body fluid volumes, but they are unfit for day-to-day care. Multifrequency bioimpedance has been shown to be of help in clinical practice in adults and its use in children and adolescents has been advocated. We investigated whether application of multifrequency bioimpedance is appropriate for total-body water (TBW) and extracellular water (ECW) measurement in children and adolescents on dialysis therapy. Study Design A study of diagnostic test accuracy. Setting & Participants 16 young dialysis patients (before a hemodialysis session or after peritoneal dialysis treatment) from the Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy, and the Emma Children's Hospital−Academic Medical Center, Amsterdam, the Netherlands. Index Test TBW and ECW volumes assessed by multifrequency bioimpedance. Reference Tests TBW and ECW volumes measured by deuterium and bromide dilution, respectively. Results Mean TBW volumes determined by multifrequency bioimpedance and deuterium dilution were 19.2 ± 8.7 (SD) and 19.3 ± 8.3 L, respectively; Bland-Altman analysis showed a mean bias between the 2 methods of −0.09 (95% limits of agreement, −2.1 to 1.9) L. Mean ECW volumes were 8.9 ± 4.0 and 8.3 ± 3.3 L measured by multifrequency bioimpedance and bromide dilution, respectively; mean bias between the 2 ECW measurements was +0.6 (95% limits of agreement, −2.3 to 3.5). Limitations Participants ingested the deuterated water at home without direct supervision by investigators, small number of patients, repeated measurements in individual patients were not performed. Conclusions Multifrequency bioimpedance measurements were unbiased but imprecise in comparison to dilution techniques. We conclude that multifrequency bioimpedance measurements cannot precisely estimate TBW and ECW in children receiving dialysis.

Original languageEnglish
Pages (from-to)428-435
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume69
Issue number3
DOIs
Publication statusPublished - 1 Mar 2017

Cite this

Milani, Gregorio P. ; Groothoff, Jaap W. ; Vianello, Federica A. ; Fossali, Emilio F. ; Paglialonga, Fabio ; Edefonti, Alberto ; Agostoni, Carlo ; Consonni, Dario ; van Harskamp, Dewi ; van Goudoever, Johannes B. ; Schierbeek, Henk ; Oosterveld, Michiel J.S. / Bioimpedance and Fluid Status in Children and Adolescents Treated With Dialysis. In: American Journal of Kidney Diseases. 2017 ; Vol. 69, No. 3. pp. 428-435.
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title = "Bioimpedance and Fluid Status in Children and Adolescents Treated With Dialysis",
abstract = "Background Assessment of hydration status in patients with chronic kidney failure treated by dialysis is crucial for clinical management decisions. Dilution techniques are considered the gold standard for measurement of body fluid volumes, but they are unfit for day-to-day care. Multifrequency bioimpedance has been shown to be of help in clinical practice in adults and its use in children and adolescents has been advocated. We investigated whether application of multifrequency bioimpedance is appropriate for total-body water (TBW) and extracellular water (ECW) measurement in children and adolescents on dialysis therapy. Study Design A study of diagnostic test accuracy. Setting & Participants 16 young dialysis patients (before a hemodialysis session or after peritoneal dialysis treatment) from the Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy, and the Emma Children's Hospital−Academic Medical Center, Amsterdam, the Netherlands. Index Test TBW and ECW volumes assessed by multifrequency bioimpedance. Reference Tests TBW and ECW volumes measured by deuterium and bromide dilution, respectively. Results Mean TBW volumes determined by multifrequency bioimpedance and deuterium dilution were 19.2 ± 8.7 (SD) and 19.3 ± 8.3 L, respectively; Bland-Altman analysis showed a mean bias between the 2 methods of −0.09 (95{\%} limits of agreement, −2.1 to 1.9) L. Mean ECW volumes were 8.9 ± 4.0 and 8.3 ± 3.3 L measured by multifrequency bioimpedance and bromide dilution, respectively; mean bias between the 2 ECW measurements was +0.6 (95{\%} limits of agreement, −2.3 to 3.5). Limitations Participants ingested the deuterated water at home without direct supervision by investigators, small number of patients, repeated measurements in individual patients were not performed. Conclusions Multifrequency bioimpedance measurements were unbiased but imprecise in comparison to dilution techniques. We conclude that multifrequency bioimpedance measurements cannot precisely estimate TBW and ECW in children receiving dialysis.",
keywords = "adolescents, body composition, body composition monitor (BCM), bromide dilution, children, deuterium dilution, extracellular water (ECW), fluid overload, fluid status, hemodialysis, Hydration status, isotope ratio mass spectrometry, multi-frequency bioimpedance measurement, pediatric, peritoneal dialysis, renal failure, stable isotopes, total body water (TBW)",
author = "Milani, {Gregorio P.} and Groothoff, {Jaap W.} and Vianello, {Federica A.} and Fossali, {Emilio F.} and Fabio Paglialonga and Alberto Edefonti and Carlo Agostoni and Dario Consonni and {van Harskamp}, Dewi and {van Goudoever}, {Johannes B.} and Henk Schierbeek and Oosterveld, {Michiel J.S.}",
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Milani, GP, Groothoff, JW, Vianello, FA, Fossali, EF, Paglialonga, F, Edefonti, A, Agostoni, C, Consonni, D, van Harskamp, D, van Goudoever, JB, Schierbeek, H & Oosterveld, MJS 2017, 'Bioimpedance and Fluid Status in Children and Adolescents Treated With Dialysis' American Journal of Kidney Diseases, vol. 69, no. 3, pp. 428-435. https://doi.org/10.1053/j.ajkd.2016.10.023

Bioimpedance and Fluid Status in Children and Adolescents Treated With Dialysis. / Milani, Gregorio P.; Groothoff, Jaap W.; Vianello, Federica A.; Fossali, Emilio F.; Paglialonga, Fabio; Edefonti, Alberto; Agostoni, Carlo; Consonni, Dario; van Harskamp, Dewi; van Goudoever, Johannes B.; Schierbeek, Henk; Oosterveld, Michiel J.S.

In: American Journal of Kidney Diseases, Vol. 69, No. 3, 01.03.2017, p. 428-435.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Bioimpedance and Fluid Status in Children and Adolescents Treated With Dialysis

AU - Milani, Gregorio P.

AU - Groothoff, Jaap W.

AU - Vianello, Federica A.

AU - Fossali, Emilio F.

AU - Paglialonga, Fabio

AU - Edefonti, Alberto

AU - Agostoni, Carlo

AU - Consonni, Dario

AU - van Harskamp, Dewi

AU - van Goudoever, Johannes B.

AU - Schierbeek, Henk

AU - Oosterveld, Michiel J.S.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background Assessment of hydration status in patients with chronic kidney failure treated by dialysis is crucial for clinical management decisions. Dilution techniques are considered the gold standard for measurement of body fluid volumes, but they are unfit for day-to-day care. Multifrequency bioimpedance has been shown to be of help in clinical practice in adults and its use in children and adolescents has been advocated. We investigated whether application of multifrequency bioimpedance is appropriate for total-body water (TBW) and extracellular water (ECW) measurement in children and adolescents on dialysis therapy. Study Design A study of diagnostic test accuracy. Setting & Participants 16 young dialysis patients (before a hemodialysis session or after peritoneal dialysis treatment) from the Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy, and the Emma Children's Hospital−Academic Medical Center, Amsterdam, the Netherlands. Index Test TBW and ECW volumes assessed by multifrequency bioimpedance. Reference Tests TBW and ECW volumes measured by deuterium and bromide dilution, respectively. Results Mean TBW volumes determined by multifrequency bioimpedance and deuterium dilution were 19.2 ± 8.7 (SD) and 19.3 ± 8.3 L, respectively; Bland-Altman analysis showed a mean bias between the 2 methods of −0.09 (95% limits of agreement, −2.1 to 1.9) L. Mean ECW volumes were 8.9 ± 4.0 and 8.3 ± 3.3 L measured by multifrequency bioimpedance and bromide dilution, respectively; mean bias between the 2 ECW measurements was +0.6 (95% limits of agreement, −2.3 to 3.5). Limitations Participants ingested the deuterated water at home without direct supervision by investigators, small number of patients, repeated measurements in individual patients were not performed. Conclusions Multifrequency bioimpedance measurements were unbiased but imprecise in comparison to dilution techniques. We conclude that multifrequency bioimpedance measurements cannot precisely estimate TBW and ECW in children receiving dialysis.

AB - Background Assessment of hydration status in patients with chronic kidney failure treated by dialysis is crucial for clinical management decisions. Dilution techniques are considered the gold standard for measurement of body fluid volumes, but they are unfit for day-to-day care. Multifrequency bioimpedance has been shown to be of help in clinical practice in adults and its use in children and adolescents has been advocated. We investigated whether application of multifrequency bioimpedance is appropriate for total-body water (TBW) and extracellular water (ECW) measurement in children and adolescents on dialysis therapy. Study Design A study of diagnostic test accuracy. Setting & Participants 16 young dialysis patients (before a hemodialysis session or after peritoneal dialysis treatment) from the Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy, and the Emma Children's Hospital−Academic Medical Center, Amsterdam, the Netherlands. Index Test TBW and ECW volumes assessed by multifrequency bioimpedance. Reference Tests TBW and ECW volumes measured by deuterium and bromide dilution, respectively. Results Mean TBW volumes determined by multifrequency bioimpedance and deuterium dilution were 19.2 ± 8.7 (SD) and 19.3 ± 8.3 L, respectively; Bland-Altman analysis showed a mean bias between the 2 methods of −0.09 (95% limits of agreement, −2.1 to 1.9) L. Mean ECW volumes were 8.9 ± 4.0 and 8.3 ± 3.3 L measured by multifrequency bioimpedance and bromide dilution, respectively; mean bias between the 2 ECW measurements was +0.6 (95% limits of agreement, −2.3 to 3.5). Limitations Participants ingested the deuterated water at home without direct supervision by investigators, small number of patients, repeated measurements in individual patients were not performed. Conclusions Multifrequency bioimpedance measurements were unbiased but imprecise in comparison to dilution techniques. We conclude that multifrequency bioimpedance measurements cannot precisely estimate TBW and ECW in children receiving dialysis.

KW - adolescents

KW - body composition

KW - body composition monitor (BCM)

KW - bromide dilution

KW - children

KW - deuterium dilution

KW - extracellular water (ECW)

KW - fluid overload

KW - fluid status

KW - hemodialysis

KW - Hydration status

KW - isotope ratio mass spectrometry

KW - multi-frequency bioimpedance measurement

KW - pediatric

KW - peritoneal dialysis

KW - renal failure

KW - stable isotopes

KW - total body water (TBW)

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