Abstract
Accurate dry weight (DW) estimation is important for hemodialysis patients. Although bioimpedance spectroscopy (BIS) is commonly used to measure DW, the BIS-based DW frequently differs from the clinical DW. We analyzed the characteristics of patients whose BIS-based DWs were over- and underestimated. In this retrospective cohort study, we evaluated 1555 patients undergoing maintenance hemodialysis in Chungnam National University Hospital. The gap (DWCP-BIS) was calculated by comparing the BIS and clinical DWs. We analyzed the clinical characteristics of patients with positive (n = 835) and negative (n = 720) gaps. Compared with other patients, the DWCP-BIS-positive group had higher extracellular water (ECW) level and extracellular/intracellular water index (E/I) and had lower weight, body mass index (BMI), lean tissue index (LTI), fat tissue index (FTI), fat mass (FAT), and adipose tissue mass (ATM). The DWCP-BIS-negative group exhibited elevated BMI, FTI, FAT, and ATM; however, it had lower height, ECW, and E/I. Linear regression analysis revealed that FAT significantly predicted DWCP accuracy. The clinical DW of patients with a low fat mass tended to be underestimated, while the clinical DW of patients with comparatively large fat reserves tended to be overestimated. These characteristics will aid in the reduction of BIS-based DW errors.
Highlights
Appropriate volume management is important in patients undergoing hemodialysis.It can be difficult to accurately determine the dry weight (DW), which comprises the lowest acceptable post-dialysis weight associated with minimal signs or symptoms of hypovolemia or hypervolemia [1]
When setting a new dry weight, patient’s condition is checked for at least 2 weeks and 200–300 g changed for each dialysis session; clinical signs judged by the medical staff and subjective symptoms of which the patient complained were combined to set the weight after dialysis to keep the patient in a stable condition
We performed linear regression analyses of fat, muscle and other parameters; we explored whether any parameter predicted the DWCP
Summary
Appropriate volume management is important in patients undergoing hemodialysis. It can be difficult to accurately determine the DW, which comprises the lowest acceptable post-dialysis weight associated with minimal signs or symptoms of hypovolemia or hypervolemia [1]. Overhydration (OH) and dehydration trigger many adverse events. Several methods are used to measure DW, including measurements of blood and jugular venous pressure, as well as edema status. These methods do not consider underlying illnesses or any reduction in muscle mass [7]. BIS assesses the volume status of hemodialysis patients and measures DW [12,13]. DW data are fairly accurate, BIS-based and clinical DWs often differ. 24–27% of dialysis patients are reportedly overhydrated, despite BIS-based monitoring of water levels [14,15]. We analyzed the characteristics of patients for whom BIS over- or underestimated DW; we sought to accurately predict the clinical DW.
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