P1185LUNG COMETS AND EVALUATION OF HYDRATION STATUS IN PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims Assessment of optimal hydration status in patients with end-stage renal disease (ESRD) on peritoneal dialysis (PD) is a challenge. Multiple diagnostic options to determine hydration status in PD patients are available. Multifrequency bioimpedance spectroscopy (MBIS) is a cheap, simple and non-invasive method of estimating body composition, including estimates of total body water (TBW), extracellular water (ECW), intracellular water (ICW) and the ratio between both spaces (ECW/ICW). Lung ultrasonography (LUS) and lung B-lines (lung comets) can be used for the evaluation of extravascular lung water. Ultrasound evaluation of inferior vena cava (UIVC) provides rapid, non-invasive assessment of a patient's hemodynamic and volume status. N-terminal pro-brain natriuretic peptide (NT-proBNP) is related to fluid status and fluid distribution. The aim of our study was to assess fluid status in PD patients comparing four different methods: MBIS, LUS, UIVC and NT-proBNP. Method We performed a single-centre cohort study in 19 PD patients. The body composition was measured using the portable whole-body MBIS device, Body Composition Monitor-BCM(®) (Fresenius Medical Care, Bad Homburg, Germany), LUS with portable US device (VScan, General Electrics Corporate), UIVC index with SonoSite US device. NT-proBNP was measured in a one-step sandwich chemiluminescent immunoassay (Dimension Vista® System 1500, Siemens Healthcare Diagnostics Inc., Newark, NJ, USA). Results The mean age of patients was 54 ± 10 years, mean dialysis vintage 53 (10-194) months, 63% were men. Thirteen (68.4%) patients had fluid overload (FO) > 1.1 L. Data of patients are presented in table 1. We found a statistically significant correlation between the number of lung comets and ECW/ICW ratio (r = 0.496, P = 0.031) and NT-proBNP (r = 0.759, P < 0.0001). In contrast, there was no significant correlation between the number of lung comets and UIVC (r = 0.221, P < 0.364). Conclusion According to our results, LUS with lung comets, MBIS with ECW/ICW ratio and NT-proBNP are useful and complementary methods for evaluation of fluid status in PD patients.

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P1303ASSOCIATION BETWEEN PULSE PRESSURE AND EXTRACELLULAR TO INTRACELLULAR WATER RATIO IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1303 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Robert Ekart ◽

Gasper Keber ◽

Benjamin Dvorsak ◽

Masa Knehtl ◽

Radovan Hojs

Keyword(s):

Blood Pressure ◽

Body Composition ◽

Diastolic Blood Pressure ◽

Pulse Pressure ◽

Significant Risk ◽

The Body ◽

Intracellular Water ◽

Whole Body ◽

Multifrequency Bioimpedance ◽

Dialysis Vintage

Abstract Background and Aims Optimal fluid management is a challenge in patients with end-stage kidney disease (ESRD) on maintenance hemodialysis (HD). Multifrequency bioimpedance spectroscopy (MBIS) is a non-invasive method to estimate body composition, including estimates of extracellular water (ECW) and intracellular water (ICW) and the ratio between both spaces (ECW/ICW). Pulse pressure is a significant risk factor of cardiovascular disease and death in general and dialysis population. Our study aimed to analyse the correlation between systolic, diastolic and pulse pressure with body composition status in ESRD patients before HD. Method We performed a retrospective single-centre cohort study in 93 HD patients. The body composition was measured using the portable whole-body MBIS device, Body Composition Monitor-BCM(®) (Fresenius Medical Care, Bad Homburg, Germany). Blood pressure was measured with OMRON monitors. Results The mean age of patients was 64 ± 13 years, mean dialysis vintage 63 (1-352) months, 61% were men, all patients had arteriovenous fistula as vascular access. Sixty-nine (74.2%) patients were fluid overload (FO) with > 1.1 L overhydration. Other data are presented in table 1. We found a statistically significant correlation between the pulse pressure and ECW/ICW ratio (r=0.258; P=0.033) in FO patients. In contrast, there was no significant correlation between systolic, diastolic blood pressure and ECW/ICW ratio in FO patients. Conclusion Only pulse pressure and not systolic or diastolic blood pressure values measured before HD are associated with ECW/ICW ratio in FO patients.

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Making the choice between bioelectrical impedance measures for body hydration status assessment

Scientific Reports ◽

10.1038/s41598-021-87253-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Dmitry M. Davydov ◽

Andrey Boev ◽

Stas Gorbunov

Keyword(s):

Body Schema ◽

Bioelectrical Impedance ◽

Information Criterion ◽

The Body ◽

Whole Body ◽

Hydration Status ◽

Status Assessment ◽

Best Fitting ◽

Body Compartments ◽

Fitting In

AbstractSituational or persistent body fluid deficit (i.e., de- or hypo-hydration) is considered a significant health risk factor. Bioimpedance analysis (BIA) has been suggested as an alternative to less reliable subjective and biochemical indicators of hydration status. The present study aimed to compare various BIA models in the prediction of direct measures of body compartments associated with hydration/osmolality. Fish (n = 20) was selected as a biological model for physicochemically measuring proximate body compartments associated with hydration such as water, dissolved proteins, and non-osseous minerals as the references or criterion points. Whole-body and segmental/local impedance measures were used to investigate a pool of BIA models, which were compared by Akaike Information Criterion in their ability to accurately predict the body components. Statistical models showed that ‘volumetric-based’ BIA measures obtained in parallel, such as distance2/Rp, could be the best approach in predicting percent of body moisture, proteins, and minerals in the whole-body schema. However, serially-obtained BIA measures, such as the ratio of the reactance to resistance and the resistance adjusted for distance between electrodes, were the best fitting in predicting the compartments in the segmental schema. Validity of these results should be confirmed on humans before implementation in practice.

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Biomechanical Aspects of the Foot Arch, Body Balance and Body Weight Composition of Boys Training Football

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18095017 ◽

2021 ◽

Vol 18 (9) ◽

pp. 5017

Author(s):

Joanna M. Bukowska ◽

Małgorzata Jekiełek ◽

Dariusz Kruczkowski ◽

Tadeusz Ambroży ◽

Jarosław Jaszczur-Nowicki

Keyword(s):

Body Composition ◽

Body Height ◽

Study Groups ◽

The Body ◽

Whole Body ◽

Training Methods ◽

Training Experience ◽

Mean Values ◽

Significance Level ◽

Body Balance

Background: The aim of the study is to assess the body balance and podological parameters and body composition of young footballers in the context of the control of football training. Methods: The study examined the distribution of the pressure of the part of the foot on the ground, the arch of the foot, and the analysis of the body composition of the boys. The pressure center for both feet and the whole body was also examined. The study involved 90 youth footballers from Olsztyn and Barczewo in three age groups: 8–10 years, 11–13 years old, and 14–16 years. The study used the Inbody 270 body composition analyzer and the EPSR1, a mat that measures the pressure distribution of the feet on the ground. Results: The results showed statistically significant differences in almost every case for each area of the foot between the groups of the examined boys. The most significant differences were observed for the metatarsal area and the left heel. In the case of stabilization of the whole body, statistically significant differences were noted between all study groups. In the case of the body composition parameters, in the examined boys, a coherent direction of changes was noticed for most of them. The relationships and correlations between the examined parameters were also investigated. The significance level in the study was set at p < 0.05. Conclusions: Under the training rigor, a statistically significant increase in stability was observed with age. The total length of the longitudinal arch of both feet of the examined boys showed a tendency to flatten in direct proportion to the age of the examined boys. Mean values of the body composition parameters reflect changes with the ontogenetic development, basic somatic parameters (body height and weight) and training experience, and thus with the intensity and volume of training. This indicates a correct training process that does not interfere with the proper development of the body in terms of tissue and biochemical composition.

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Follow-up of GK rats during prediabetes highlights increased insulin action and fat deposition despite low insulin secretion

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00501.2007 ◽

2008 ◽

Vol 294 (1) ◽

pp. E168-E175 ◽

Cited By ~ 32

Author(s):

Jamileh Movassat ◽

Danièle Bailbé ◽

Cécile Lubrano-Berthelier ◽

Françoise Picarel-Blanchot ◽

Eric Bertin ◽

...

Keyword(s):

Body Composition ◽

Insulin Secretion ◽

Insulin Sensitivity ◽

Cell Function ◽

Cell Mass ◽

The Body ◽

Whole Body ◽

Β Cell ◽

Gk Rats

The adult Goto-Kakizaki (GK) rat is characterized by impaired glucose-induced insulin secretion in vivo and in vitro, decreased β-cell mass, decreased insulin sensitivity in the liver, and moderate insulin resistance in muscles and adipose tissue. GK rats do not exhibit basal hyperglycemia during the first 3 wk after birth and therefore could be considered prediabetic during this period. Our aim was to identify the initial pathophysiological changes occurring during the prediabetes period in this model of type 2 diabetes (T2DM). To address this, we investigated β-cell function, insulin sensitivity, and body composition in normoglycemic prediabetic GK rats. Our results revealed that the in vivo secretory response of GK β-cells to glucose is markedly reduced and the whole body insulin sensitivity is increased in the prediabetic GK rats in vivo. Moreover, the body composition of suckling GK rats is altered compared with age-matched Wistar rats, with an increase of the number of adipocytes before weaning despite a decreased body weight and lean mass in the GK rats. None of these changes appeared to be due to the postnatal nutritional environment of GK pups as demonstrated by cross-fostering GK pups with nondiabetic Wistar dams. In conclusion, in the GK model of T2DM, β-cell dysfunction associated with increased insulin sensitivity and the alteration of body composition are proximal events that might contribute to the establishment of overt diabetes in adult GK rats.

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MO047COMPARISON BETWEEN DUAL-ENERGY X-RAY ABSORPTIOMETRY AND BIOELECTRICAL IMPEDANCE FOR BODY COMPOSITION MEASUREMENTS IN ADULTS WITH CHRONIC KIDNEY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa140.mo047 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Natália Tomborelli Bellafronte ◽

Lorena Vega-Piris ◽

Paula Garcia Chiarello ◽

Guillermina Barril Cuadrado

Keyword(s):

Chronic Kidney Disease ◽

Body Composition ◽

Peritoneal Dialysis ◽

Renal Transplantation ◽

Bioelectrical Impedance ◽

Total Sample ◽

Dual Energy ◽

Error Tolerance ◽

Whole Body ◽

X Ray

Abstract Background and Aims Chronic kidney disease (CKD) patients frequently have an altered body composition driven by metabolic disorders from the uremic syndrome that usually leads to increased protein catabolism, with obesity and muscle impairment being common conditions associated with worse clinical prognosis and high mortality rates. Therefore, with increased mortality and disability rates of CKD patients in the last quarter of a century and the association of a poor body composition with low survival, routine and longitudinal assessment of body composition could improve clinical outcomes. Due to limited availability of reference methods to assess nutritional status, alternative methods are used. In view of the above, our goal was to evaluate the agreement between multifrequency bioelectrical impedance spectroscopy (BIS) and Dual-energy X-ray Absorptiometry (DXA) for assessment of body composition in CKD. Method Cross-sectional and prospective analyses by DXA (Hologic, GE®) and BIS (BCM, Fresenius Medical Care®) in whole-body (BISWB) and segmental (BISSEG) protocols were performed in CKD non-dialysis-dependent, hemodialysis and peritoneal dialysis (for at least 3 months), and renal transplantation (for at least 6 months) adult (18 ≤ age ≤ 60 years old) patients. Measurements were performed consecutively by the same professional after an 8-hour fast, drainage of the peritoneal dialysate and just after the midweek hemodialysis session. Intraclass correlation coefficient (ICC) and Bland-Altman plots were evaluated for agreement analysis in group and individual levels, respectively; linear regression analysis was performed for bias assessment and development of new equations; ROC curve was constructed for diagnosis of inadequate error tolerance (DXA - BIS > ± 2kg). Results A total of 266 patients were included: 137 men (M) and 129 women (W); 81 were in non-dialysis-dependent treatment, 83 in hemodialysis, 24 in peritoneal dialysis, and 80 had renal transplantation. Total sample had a mean age of 47 ± 10 years old. CKD was secondary to systemic arterial hypertension in 29% of the total sample, to glomerulonephritis in 25%, to diabetes mellitus in 10%, to polycystic kidney in 7%, to glomerulosclerosis and systemic syndromes in 8%, and to other causes and unknown etiology in 20%. Fourteen patients (4 M and 10 W) were in automated and 9 (4 M and 5 W) in continuous ambulatory PD. KTx was by living donor in 18 (14 M and 4 W) and by deceased donor in 63 (34 M and 29 W) patients. The agreement with DXA was greater for BISWB than BISSEG; for fat mass (FM) (ICC in M = 0.89; ICC in W = 0.93) than for fat free mass (FFM) (ICC in M = 0.57; ICC in W = 0.52). Bland-Altman plots showed high limits of agreement (FFM: from -9.51 to 15.64kg; FM: from -7.71 to 7.32kg) with greater bias for FFM as muscular mass increases and for FM in extremes of body fat. The agreement was lower when using the prospective data (body change analysis) (ICC for FFM in M = 0.20; ICC for FFM in W = 0.49; ICC for FM in M = 0.46; ICC for FM in W = 0.58). The factors that interfered in bias between methods were extra to intracellular water ratio (ECW/ICW), body mass index, fat mass index, waist circumference, resistance and reactance (adjusted r2 for FFM = 0.90; r2 for FM = 0.87). FFM had poorer agreement in the last tertile of ECW/ICW sample (ICC in M = 0.69, 0.68 and 0.51; ICC in W = 0.71, 0.74 and 0.38 for first, second and third tertiles, respectively). An ECW/ICW cut-off point of > 0.725 for inadequate error tolerance was determined. New prediction equations for FFM (r2 = 0.91) and FM (r2 = 0.89) presented adequate error tolerance in 55% and 63% in the validation sample compared to 30% and 39% of the original equation, respectively. Conclusion For body composition evaluation in CKD, BIS applied using the whole-body protocol, in normal hydration CKD patients is as reliable as DXA; BIS must be used with caution among overhydrated patients with ECW/ICW > 0.725. The newly developed equations are indicated for greater precision.

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Hydration Status Is Associated with Aortic Stiffness, but Not with Peripheral Arterial Stiffness, in Chronically Hemodialysed Patients

International Journal of Nephrology ◽

10.1155/2015/628654 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 5

Author(s):

Daniel Bia ◽

Cintia Galli ◽

Rodolfo Valtuille ◽

Yanina Zócalo ◽

Sandra A. Wray ◽

...

Keyword(s):

Blood Pressure ◽

Arterial Stiffness ◽

Body Fluid ◽

Fluid Management ◽

Blood Pressure Level ◽

Whole Body ◽

Volume Status ◽

Hydration Status ◽

Fluid Status ◽

Peripheral Arterial

Background. Adequate fluid management could be essential to minimize high arterial stiffness observed in chronically hemodialyzed patients (CHP).Aim. To determine the association between body fluid status and central and peripheral arterial stiffness levels.Methods. Arterial stiffness was assessed in 65 CHP by measuring the pulse wave velocity (PWV) in a central arterial pathway (carotid-femoral) and in a peripheral pathway (carotid-brachial). A blood pressure-independent regional arterial stiffness index was calculated using PWV. Volume status was assessed by whole-body multiple-frequency bioimpedance. Patients were first observed as an entire group and then divided into three different fluid status-related groups: normal, overhydration, and dehydration groups.Results. Only carotid-femoral stiffness was positively associated (P<0.05) with the hydration status evaluated through extracellular/intracellular fluid, extracellular/Total Body Fluid, and absolute and relative overhydration.Conclusion. Volume status and overload are associated with central, but not peripheral, arterial stiffness levels with independence of the blood pressure level, in CHP.

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Estimation of Body Composition and Normal Fluid Status Using a Calf Bioimpedance Technique

Blood Purification ◽

10.1159/000368937 ◽

2015 ◽

Vol 39 (1-3) ◽

pp. 25-31 ◽

Cited By ~ 9

Author(s):

Fansan Zhu ◽

Nathan W. Levin

Keyword(s):

Body Composition ◽

Gold Standard ◽

Dry Weight ◽

Practical Method ◽

The Body ◽

Normal Fluid ◽

Fluid Status ◽

Body Composition Study ◽

Highly Correlated ◽

A Prospective Study

The aims of this study in hemodialysis (HD) patients were: 1. To evaluate the relationship of calf bioimpedance with total body composition and fluid status as measured by gold standard methods. 2. To investigate the ability of calf normalized resistivity (CNR) to predict the normal fluid status (dry weight: DW) in a prospective study. In the body composition study (n = 41), fluid status (ECVBr/FFMMRI), muscle mass (MMMRI), and total adipose tissue (TATMRI) were measured by dilution (D2O and Br) and MRI methods three hours prior to HD treatment. Calf extracellular and intracellular resistance, resistivity, and CNR were measured with a multi-frequency bioimpedance device (Hydra 4200). In the fluid status study (n = 32 with 429 measurements), a nonlinear model based on the differences in CNR between patients and healthy subjects was established to predict DWcBIS previously determined by a separate continuous calf bioimpedance spectroscopy (cBIS) method. CNR significantly correlated with a gold standard hydration marker (ECVBr/FFMMRI). Calf body composition models were highly correlated with MMMRI (R2 = 0.85) and TATMRI (R2 = 0.85). DWcBIS prediction was validated with a CNR model in the degree of differences of 0.94 ± 0.18, 0.39 ± 0.7 and -0.02 ± 0.8 kg from DWcBIS when post HD fluid overload was 1.8 ± 1.2, 1.15 ± 0.8 and 0.54 ± 0.5 kg, respectively. These differences are not considered to be clinically significant. Conclusion: This practical method of calf bioimpedance is useful to predict body composition and normal fluid status in dialysis patients.

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Renal interstitial hyaluronan: functional aspects during normal and pathological conditions

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00332.2011 ◽

2012 ◽

Vol 302 (11) ◽

pp. R1235-R1249 ◽

Cited By ~ 23

Author(s):

Sara Stridh ◽

Fredrik Palm ◽

Peter Hansell

Keyword(s):

Current Knowledge ◽

Stone Formation ◽

Ischemia Reperfusion ◽

The Body ◽

Receptor Expression ◽

Whole Body ◽

Hydration Status ◽

Hyaluronan Synthases ◽

Pathological Conditions

The glycosaminoglycan (GAG) hyaluronan (HA) is recognized as an important structural component of the extracellular matrix, but it also interacts with cells during embryonic development, wound healing, inflammation, and cancer; i.e., important features in normal and pathological conditions. The specific physicochemical properties of HA enable a unique hydration capacity, and in the last decade it was revealed that in the interstitium of the renal medulla, where the HA content is very high, it changes rapidly depending on the body hydration status while the HA content of the cortex remains unchanged at very low amounts. The kidney, which regulates fluid balance, uses HA dynamically for the regulation of whole body fluid homeostasis. Renomedullary HA elevation occurs in response to hydration and during dehydration the opposite occurs. The HA-induced alterations in the physicochemical characteristics of the interstitial space affects fluid flux; i.e., reabsorption. Antidiuretic hormone, nitric oxide, angiotensin II, and prostaglandins are classical hormones/compounds involved in renal fluid handling and are important regulators of HA turnover during variations in hydration status. One major producer of HA in the kidney is the renomedullary interstitial cell, which displays receptors and/or synthesis enzymes for the hormones mentioned above. During several kidney disease states, such as ischemia-reperfusion injury, tubulointerstitial inflammation, renal transplant rejection, diabetes, and kidney stone formation, HA is upregulated, which contributes to an abnormal phenotype. In these situations, cytokines and other growth factors are important stimulators. The immunosuppressant agent cyclosporine A is nephrotoxic and induces HA accumulation, which could be involved in graft rejection and edema formation. The use of hyaluronidase to reduce pathologically overexpressed levels of tissue HA is a potential therapeutic tool since diuretics are less efficient in removing water bound to HA in the interstitium. Although the majority of data describing the role of HA originate from animal and cell studies, the available data from humans demonstrate that an upregulation of HA also occurs in diabetic kidneys, in transplant-rejected kidneys, and during acute tubular necrosis. This review summarizes the current knowledge regarding interstitial HA in the role of regulating kidney function during normal and pathological conditions. It encompasses mechanistic insights into the background of the heterogeneous intrarenal distribution of HA; i.e., late nephrogenesis, its regulation during variations in hydration status, and its involvement during several pathological conditions. Changes in hyaluronan synthases, hyaluronidases, and binding receptor expression are discussed in parallel.

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