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      Call for Papers: Green Renal Replacement Therapy: Caring for the Environment

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      Body Composition Assessed by Impedance Changes Very Early with Declining Renal Graft Function

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          Abstract

          Background: Kidney transplant (Tx) restores renal filtration, although it does not achieve the function of two native kidneys, and with time it may variably involute back to chronic renal failure. We hypothesized that bioelectrical impedance analysis (BIA) might highlight differences for body compartments among Tx with different filtration rates, and we compared them with healthy controls. Methods: 38 Tx patients (25 males, 13 females) were studied at 75.9 ± 37.8 months postsurgery and divided into three groups: good creatinine clearance (CrCl, ml/min/1.73 m<sup>2</sup>; > 65.0), borderline (35.0 < CrCl < 60.0) and bad (CrCl < 35.0). BIA was assessed three times in a year. Total body water, extracellular water (ECW), intracellular water (ICW), Na:K exchange rate (Nae:Ke) and phase angle were studied. Healthy (n = 11) and hemodialysis (n = 11) groups were also studied. Results: BIA showed no differences between healthy controls and good Tx while both borderline and bad Tx presented a significantly higher ECW and lower ICW than either good Tx or normal controls. Only good CrCl was different from predialysis. Conclusions: A good kidney graft manages to restore and maintain normal body composition, even with potential disturbances brought about by steroids and cyclosporine. With mild renal dysfunction a change in body compartments was observed, moving towards the composition of that with chronic renal failure patients.

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          Nutritional and prognostic correlates of bioimpedance indexes in hemodialysis patients.

          Quirino Maggiore, Santi Nigrelli, Carla Ciccarelli … (1996)
          We carried out a cross sectional and longitudinal study to assess whether bioimpedance indexes (resistance, Rz; reactance, Xc; phase angle, PA) reflect the nutritional status of hemodialysis (HD) patients, and bear a significant association with their long-term survival. The bioimpedance data of 131 patients on chronic HD treatment were compared with those of 272 healthy controls matched for age and sex. Nutritional status was assessed by anthropometric variables, serum albumin (SA), normalized protein catabolic rate (nPCR), and subjective global assessment (SGA). All three bioimpedance indexes varied significantly with HD treatment, however, with the exception of Xc in post-HD, they were on average significantly (P < 0.016) different from controls either pre- and post-HD. Post-HD PA appeared to be the best index of nutritional status, being significantly correlated with SA, age, mid arm muscle circumference (MAMC), SGA, and nPCR (R2 = 0.44; P < 0.01). However, depending on the cut-off levels, PA failed to detect clinically overt malnutrition in one to two thirds of the patients with the worst SGA score. During the follow-up the changes in bioimpedance indexes reflected poorly the changes in dry blood weight, only delta Rz bore a significant correlation (r = 0.29; P < 0.01) with delta body wt. Patients having baseline phase angle values within the lower quartile had a significantly lower two-year survival rate than patients having higher values (59.3% vs. 91.3%; P < 0.01). Cox's analysis (proportional hazard model) showed that phase angle as a predictor of death outweighed all other parameters included in the model (age, SA, nPCR, MAMC, SGA), with a relative risk of 2.6 (95% CI = 1.6 to 4.2). Bioimpedance indexes do not appear to be reliable in detecting clinically overt depletion of lean body mass. However, the strong association of PA with patient survival suggests that this bioimpedance index reflects some dimension of the illness, which is not fully identifiable with the deranged nutritional status.
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            Relationship of bioelectrical impedance parameters to nutrition and survival in peritoneal dialysis patients.

            N Mittman, Dhruba Chattopadhyay, Adrian Avram … (2003)
            Malnutrition is highly prevalent in peritoneal dialysis (PD) patients and is associated with higher mortality in these patients. In this study, we have prospectively examined the relationship of bioimpedance indexes to the nutritional status and survival in PD patients. We enrolled 48 PD patients beginning in November 2000. On enrollment, bioelectrical impedance analysis (BIA) (BIA-101; RJL/Akern, Clinton Township, MI, USA) was performed and monthly blood was analyzed for biochemical markers, including prealbumin. Patients were followed until April 2003. The mean age of PD patients was 51 +/- 15 (SD) years. Fifty-eight percent of the patients were female and 23% of the patients were diabetic. Mean body mass index (BMI) was 25.7 +/- 5.0 kg/m2. Mean resistance, reactance, and phase angle were 521 +/- 104 ohms, 57 +/- 19 ohms, and 6.16 +/- 1.6 degrees, respectively. During the study period, 8 patients (17%) expired. The Kaplan-Meier method was used to compute observed survival. The cumulative observed survival of PD patients with enrollment phase angle greater than or equal to 6 degrees was significantly higher (P = 0.008) than that of patients with phase angle less than 6. Using Cox's multivariate regression analysis, phase angle was an independent predictor (relative risk = 0.39, P = 0.027) of more than two years' survival in PD patients. Serum prealbumin was directly correlated with phase angle (r = 0.54, P < 0.0001), reactance (r = 0.55, P < 0.0001), and resistance (r = 0.29, P = 0.06). BIA indexes reflect nutritional status and may be useful in monitoring nutritional status in PD patients. Phase angle is a strong prognostic index in PD patients. It is useful to incorporate prealbumin and BIA parameters in the regular assessment of PD patients, whose survival may be improved by better management of malnutrition and overall health status.
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              Bioimpedance norms for the hemodialysis population.

              Glenn Chertow, J Lazarus, Nancy Lew … (1997)
              More than 3,000 hemodialysis patients were examined with single-frequency bioelectrical impedance analysis (BIA). Distributions of resistance, reactance, phase angle (PA), and estimates of total body water (TBW) and body cell mass (BCM) by BIA were determined, and compared with traditional laboratory markers of nutritional status. Bioimpedance parameters and body composition estimates differed significantly by age, sex, race, and diabetic status. PA and BCM correlated directly with serum creatinine, albumin, and prealbumin concentrations. Population-based norms for bioimpedance parameters and estimates of body composition are provided.
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                Author and article information

                Journal
                Journal ID (publisher-id): NEP
                Journal ID (nlm-ta): Nephron Physiol
                Journal ID (doi): 10.1159/issn.1660-2137
                Title: Nephron Physiology
                Publisher: S. Karger AG
                ISSN (Electronic): 1660-2137
                Publication date Subscription-year: 2006
                Publication date (Print): October 2006
                Publication date (Electronic): 13 October 2006
                Volume: 104
                Issue: 3
                Pages: p115-p120
                Affiliations
                aFaculty of Nutrition and Food Sciences, bFaculty of Medicine and cNephrology Department, S. João Hospital, Porto, Portugal
                Article
                Publisher ID: 95540 Other ID: Nephron Physiol 2006;104:p115–p120
                DOI: 10.1159/000095540
                PubMed ID: 16940749
                SO-VID: 1ed17a49-9cf9-40ea-9c36-911e1d0da7a9
                Copyright © © 2006 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 14 January 2004
                Date accepted : 03 May 2006
                Page count
                Figures: 1, Tables: 2, References: 32, Pages: 1
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Renal transplant,Bioimpedance,Extracellular water,Hemodialysis,Chronic renal failure
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Renal transplant, Bioimpedance, Extracellular water, Hemodialysis, Chronic renal failure

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