Calf Bioimpedance Ratio Improves Dry Weight Assessment and Blood Pressure Control in Hemodialysis Patients

Background: Chronic fluid overload due to overestimation of dry weight (DW) is the major factor in the development of hypertension in hemodialysis (HD) patients. The present study was undertaken to investigate whether bioimpedance ratio in the calf (Calf-BR = impedance at 200 kHz/impedance at 5 kHz) could be a useful hydration marker for estimation of DW and facilitate better control of blood pressure (BP) in HD patients. Methods: Target range of Calf-BR was derived from 157 healthy Chinese subjects. Post-dialysis Calf-BR was measured in 117 stable, non-edematous HD patients. Those with Calf-BR(s) above target level had their DW(s) gradually reduced under the guidance of Calf-BR. Results: The Calf-BR was normally distributed and increased with age, but was independent of BMI and gender in both healthy subjects and dialysis patients. HD patients with Calf-BR above age-stratified target range had significantly higher home BP, in spite of more antihypertensive treatments (p = 0.058). The patients who reached the target range of Calf-BR by decreasing DW, had their home BP significantly decreased, along with reduction in antihypertensive medications (p = 0.012). Conclusion: Recognition and correction of chronic fluid overload based on age-stratified Calf-BR is helpful in hypertension control in Chinese HD patients.

[1]  C. G. Olthof,et al.  Assessment of post-dialysis dry weight: an application of the conductivity measurement method. , 1992, Kidney international.

[2]  R V Patel,et al.  Estimation of Total Body and Extracellular Water Using Single-and Multiple-Frequency Bioimpedance , 1994, The Annals of pharmacotherapy.

[3]  W. Hannan,et al.  Evaluation of multi-frequency bio-impedance analysis for the assessment of extracellular and total body water in surgical patients. , 1994, Clinical science.

[4]  G. Chertow,et al.  Multifrequency bioelectrical impedance estimates the distribution of body water. , 1995, Journal of applied physiology.

[5]  B. Charra,et al.  Importance of treatment time and blood pressure control in achieving long-term survival on dialysis. , 1996, American journal of nephrology.

[6]  M. Jaffrin,et al.  Extracellular and intracellular fluid volume monitoring during dialysis by multifrequency impedancemetry. , 1996, ASAIO journal.

[7]  A. Melander,et al.  Comparison of dose standard units for drug utilisation studies , 1996, European Journal of Clinical Pharmacology.

[8]  G. Chertow,et al.  Bioimpedance norms for the hemodialysis population. , 1997, Kidney international.

[9]  J. Matthie,et al.  Predicting body cell mass with bioimpedance by using theoretical methods: a technological review. , 1997, Journal of applied physiology.

[10]  B. Charra.  'Dry weight' in dialysis: the history of a concept. , 1998, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[11]  N. Levin,et al.  Validation of changes in extracellular volume measured during hemodialysis using a segmental bioimpedance technique. , 1998, ASAIO journal.

[12]  R. Mehta,et al.  Assessment of dry weight in hemodialysis: an overview. , 1999, Journal of the American Society of Nephrology : JASN.

[13]  C. Pollock,et al.  Comparing different methods of assessing body composition in end-stage renal failure. , 2000, Kidney international.

[14]  B. Fisch,et al.  Bioimpedance resistance ratios for the evaluation of dry weight in hemodialysis. , 2000, Clinical nephrology.

[15]  B. Grabensee,et al.  Comparison of body fluid distribution between chronic haemodialysis and peritoneal dialysis patients as assessed by biophysical and biochemical methods. , 2001, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[16]  A. P. Heidenheim,et al.  Preserving Central Blood Volume: Changes in Body Fluid Compartments During Hemodialysis , 2001, ASAIO journal.

[17]  F. Lopot,et al.  Age-Related Extracellular to Total Body Water Volume Ratio (ECV/TBW) - Can it be Used for “Dry Weight” Determination in Dialysis Patients? Application of Multifrequency Bioimpedance Measurement , 2002, The International journal of artificial organs.

[18]  F. Timio,et al.  Association between extracellular water, left ventricular mass and hypertension in haemodialysis patients. , 2003, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[19]  Allen R Nissenson,et al.  Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. , 2003, The American journal of medicine.

[20]  G. Nesrallah,et al.  Hemodynamic and Volume Changes during Hemodialysis , 2003, Hemodialysis international. International Symposium on Home Hemodialysis.

[21]  N. Levin,et al.  Adjustment of dry weight in hemodialysis patients using intradialytic continuous multifrequency bioimpedance of the calf. , 2004, The International journal of artificial organs.

[22]  R. Agarwal.  Hypertension and survival in chronic hemodialysis patients--past lessons and future opportunities. , 2005, Kidney international.

[23]  C. Saha,et al.  Home blood pressure monitoring improves the diagnosis of hypertension in hemodialysis patients. , 2006, Kidney international.

[24]  C. Saha,et al.  Out-of-Hemodialysis-Unit Blood Pressure Is a Superior Determinant of Left Ventricular Hypertrophy , 2006, Hypertension.

[25]  PCNA: Preventive Cardiovascular Nurses Association. , 2006, The Journal of cardiovascular nursing.

[26]  R. Agarwal,et al.  Home blood pressures are of greater prognostic value than hemodialysis unit recordings. , 2007, Clinical journal of the American Society of Nephrology : CJASN.

[27]  B. Charra,et al.  Fluid balance, dry weight, and blood pressure in dialysis , 2007, Hemodialysis international. International Symposium on Home Hemodialysis.

[28]  Jongha Park,et al.  Usefulness of Segmental Bioimpedance Ratio to Determine Dry Body Weight in New Hemodialysis Patients: A Pilot Study , 2008, American Journal of Nephrology.

[29]  Yutaka Imai,et al.  European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring , 2008, Journal of hypertension.

[30]  David Goff,et al.  Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: A Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association , 2008, The Journal of cardiovascular nursing.

[31]  P Kotanko,et al.  A method for the estimation of hydration state during hemodialysis using a calf bioimpedance technique , 2008, Physiological measurement.

[32]  R. Agarwal,et al.  Dry-Weight Reduction in Hypertensive Hemodialysis Patients (DRIP): A Randomized, Controlled Trial , 2009, Hypertension.

[33]  R. Agarwal,et al.  Can chronic volume overload be recognized and prevented in hemodialysis patients? The pitfalls of the clinical examination in assessing volume status. , 2009, Seminars in dialysis.