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Journal of the American Society of Nephrology, 1995, 6:75-81.
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Nutritional assessment with bioelectrical impedance analysis in maintenance hemodialysis patients.
Glenn M. Chertow (1), Edmond G. Lowrie (4), Douglas W. Wilmore (2), Jorge Gonzalez (2), Nancy L. Lew (4), Jie Ling (4), Meryl S. Leboff (3), Michael N. Gottlieb (5), Wei Huang (4), Barbara Zebrowski (4), Joyce College (4), and Michael Lazarus (1).
(1) Renal Division, Department of Medicine Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
(2) Laboratories for Surgical Metabolism and Nutrition, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
(3) Endocrine-Hypertension Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
(4) National Medical Care, Inc., Waltham, MA.
(5) Department of Medicine, Metro West Medical Center, Framingham, MA.
Abstract: Protein energy malnutrition is common among persons with ESRD and contributes
substantially to morbidity and morality. The usual methods of nutritional assessment,
such as anthropometry, can be misleading because of altered tissue hydration.
Bioelectrical impedance analysis (BIA) has been recommended by some as a practical
nutritional assessment tool but has not been validated in patients with ESRD.
Thirty-three stable patients on maintenance hemodialysis were evaluated in an
ambulatory clinical research center with simultaneous BIA, dual-energy x-ray absorptiometry,
and deuterium oxide (D2O) and sodium bromide (NaBr) isotope dilution studies.
Standard determinations of total body water (TBW) and body cell mass (BCM) were
obtained and compared with values estimated by BIA. Two separate outpatient BIA
measurements were also obtained approximately 2 wks before and after the clinical
research center evaluation. BCM estimated by BIA was directly correlated (r =
0.92, P < 0.0001) with BCM determined by DEXA and NaBr. TBW estimated by BIA was
directly correlated (r = 0.96, P < 0.0001) with TBW determined by deuterium oxide
dilution. The reactance to resistance ratio (Xc/R) derived from BIA was inversely
correlated (r = - 0.73, P < 0.0001) with the extracellular water/TBW ratio determined
by NaBr/D2O. Bland-Altman analyses showed that for TBW, BIA was in excellent agreement
with D2O dilution. BCM was modestly underestimated by BIA compared with the dual-energy
x-ray absorptiometry/NaBr standard and was adjusted by linear regression. The
coefficients of variation on repeated BIA measurements were below 4%, demonstrating
test-retest reliability. BIA is a valid and reliable method of nutritional assessment
in maintenance hemodialysis patients. |
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