Bioimpedance spectroscopy for fluid status assessment in patients with decompensated liver cirrhosis: Implications for peritoneal dialysis

Elisabeth Schwaiger,Matthäus Ernstbrunner,Georg Hinterholzer,Amrei Simon,Philipp Schwabl,Lorenzo Signorini,Manfred Hecking,Florian Frommlet,Christian J Müller,Andreas Vychytil,Benjamin Schairer,Peter Wabel,Rayko Evstatiev,Carolin Berner

doi:10.1038/s41598-020-59817-3

Abstract

Bioimpedance spectroscopy (BIS) is routinely used in peritoneal dialysis patients and might aid fluid status assessment in patients with liver cirrhosis, but the effect of ascites volume removal on BIS-readings is unknown. Here we determined changes in BIS-derived parameters and clinical signs of fluid overload from before to after abdominal paracentesis. Per our pre-specified sample size calculation, we studied 31 cirrhotic patients, analyzing demographics, labs and clinical parameters along with BIS results. Mean volume of the abdominal paracentesis was 7.8 ± 2.6 L. From pre-to post-paracentesis, extracellular volume (ECV) decreased (20.2 ± 5.2 L to 19.0 ± 4.8 L), total body volume decreased (39.8 ± 9.8 L to 37.8 ± 8.5 L) and adipose tissue mass decreased (38.4 ± 16.0 kg to 29.9 ± 12.9 kg; all p < 0.002). Correlation of BIS-derived parameters from pre to post-paracentesis ranged from R² = 0.26 for body cell mass to R² = 0.99 for ECV. Edema did not correlate with BIS-derived fluid overload (FO ≥ 15% ECV), which occurred in 16 patients (51.6%). In conclusion, BIS-derived information on fluid status did not coincide with clinical judgement. The changes in adipose tissue mass support the BIS-model assumption that fluid in the peritoneal cavity is not detectable, suggesting that ascites (or peritoneal dialysis fluid) mass should be subtracted from adipose tissue if BIS is used in patients with a full peritoneal cavity.

Highlights

Bioimpedance spectroscopy (BIS) is routinely used in peritoneal dialysis patients and might aid fluid status assessment in patients with liver cirrhosis, but the effect of ascites volume removal on BISreadings is unknown
The etiology of the liver cirrhosis causing ascites was as follows: 14 patients suffered from alcohol-induced liver cirrhosis, 7 patients from viral hepatitis, 7 patients from liver cirrhosis of unknown origin, 1 patient had autoimmune hepatitis causing liver cirrhosis, 1 patient had Budd-Chiari syndrome and 1 patient had non-alcoholic steatohepatitis
The present study shows that (i) more than half (51.6%) of our study cohort patients were fluid overloaded, (ii) the results of the clinical assessment of FO differed significantly from the results of the Body Composition Monitor (BCM)-BIS device and (iii) the removal of ascites did not influence the FO or LTM results obtained by BIS using the BCM-BIS device

Summary

Introduction

Bioimpedance spectroscopy (BIS) is routinely used in peritoneal dialysis patients and might aid fluid status assessment in patients with liver cirrhosis, but the effect of ascites volume removal on BISreadings is unknown. The changes in adipose tissue mass support the BIS-model assumption that fluid in the peritoneal cavity is not detectable, suggesting that ascites (or peritoneal dialysis fluid) mass should be subtracted from adipose tissue if BIS is used in patients with a full peritoneal cavity Liver cirrhosis impairs both the splanchnic and the systemic circulation resulting in a “hyperdynamic circulatory syndrome”[1,2,3]. Filling of the peritoneal cavity occurs both in cirrhotic patients with portal hypertension, who develop ascites[19,20], and in patients undergoing PD. The disunity is mirrored by different filling status throughout various studies using BIS: some researchers measured with a full abdomen[24,25,26], others after the abdomen was drained[27,28,29,30], or did not elaborate on the matter, assuming there is no difference[31,32]

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