DIALYSIS OUTCOMES Quality Initiative
|
|
- Anna Casey
- 5 years ago
- Views:
Transcription
1 Bipedal Bioelectrical Impedance Analysis Reproducibly Estimates Total Body Water in Hemodialysis Patients Robert F. Kushner, MD, and David M. Roxe, MD Formal kinetic modeling for hemodialysis patients requires accurate determination of in vivo dialyzer clearance, careful measurement of the actual dialysis time, and calculation of the patient s total body water (V) or urea space. Bipedal (BP) bioelectrical impedance analysis (BIA) is a simple method for the determination of V at the same time the patient is weighed. Because of better correlation with the Watson formula volume and a smaller coefficient of variation than urea kinetic volumes, BP-BIA estimates of V may be preferred in dialysis units that meet guidelines by following formal kinetic modeling data or use V estimates in calculating treatment time by the National Kidney Foundation, Inc. INDEX WORDS: Kinetic modeling; total body water (V); urea space; bioelectrical impedance; hemodialysis (HD). DIALYSIS OUTCOMES Quality Initiative (DOQI) guidelines specify that The delivered dose of hemodialysis in adult and pediatric patients should be measured using formal kinetic modeling, employing the single-pool, variable volume model. 1 Many dialysis units substitute use of the urea reduction ratio as a surrogate for formal modeling because of difficulties associated with the procedure. Difficulties include knowing actual dialyzer clearance, accurately measuring the true dialysis time, and quantifying the urea distribution space or total body water (V). Of these, perhaps the most difficult to define for a given patient is the volume of V. The purpose of this study is to investigate the utility and practicality of bipedal (BP) bioelectrical impedance analysis (BIA) to estimate the volume of V (BP-BIA-V) in dialysis patients and compare that value with volumes estimated from a standard urea kinetic (UK) technique (UK-V) and the Watson formula (W-V). METHODS Subjects Fourteen adult patients (7 men, 7 women) with end-stage renal disease undergoing chronic outpatient hemodialysis From the Northwestern University Medical School, Chicago, IL. Received January 9, 2001; accepted in revised form July 27, Supported in part by a grant from Tanita Corporation of America, Arlington Heights, IL; and Mr. and Mrs. Everett P. Weaver (D.M.R.). Address reprint requests to Robert F. Kushner, MD, Wellness Institute, Northwestern Memorial Hospital, 150 East Huron, Suite 1100, Chicago, IL rkushner@nmh.org 2002 by the National Kidney Foundation, Inc /02/ $35.00/0 doi: /ajkd therapy were recruited for the study. All patients were medically stable and dialyzed on a thrice-weekly schedule at Northwestern Memorial Hospital (Chicago, IL). None of those studied had a pacemaker or implanted defibrillator. Measurements (described next) were performed during four consecutive hemodialysis sessions. Eighteen healthy adult subjects (8 men, 10 women) served as controls. The study was approved by the Northwestern University Institutional Review Board, and all participants signed an informed consent form. Protocol BP-BIA. Immediately before hemodialysis, patients stood barefoot on the BP-BIA device (TBF-105; Tanita Corp of America, Arlington Heights, IL). In this system, a leg-to-leg conduction pathway is used for impedance measurements. Two subdivided steel foot-pad electrodes are mounted on a platform scale. Each foot is divided in half so that the anterior and posterior portions form two separate electrodes. Current is applied through the anterior portion of the footpad electrode, and the voltage decrease across the posterior (heel) electrode is then measured. Impedance of the lower extremities and body weight is measured simultaneously while the subject stands on the scale. Measurement of impedance uses a standard 50 khz to 0.8 ma sine wave constant current. 2 Measured impedance (ohms) and estimated V using the manufacturer s predictive equations were recorded. These equations incorporate variable impedance, height, weight, age, and sex for the prediction of V. Height was measured by a wall-mounted statiometer to the nearest 0.1 cm. Watson equations. Anthropometrically derived sexspecific urea distribution volumes were calculated using the Watson equations, 3 as cited in the DOQI guidelines. Equations were generated from 458 adult men and 265 adult women obtained from dilution studies. Subjects were selected representing a wide range of height, weight, percentage of body fat, and total body water (TBW). Most individuals were healthy, and none had clinical evidence of edema or conditions that would affect normal water metabolism. These equations are commonly used in clinical practice for pharmacokinetic estimates of V (W-V). SDs and total variances (r 2 ) for equations for men and women are 3.76 l and 70.4% and 3.60 l and 73.6%, respectively. W-V was calculated before each dialysis session as follows: 154 American Journal of Kidney Diseases, Vol 39, No 1 (January), 2002: pp
2 BIPEDAL BIOELECTRICAL IMPEDANCE AND DIALYSIS 155 (Men) V (age) (height) (weight) (Women) V (height) (weight) where V is in liters, age is in years, height is in centimeters, and weight is in kilograms. UK modeling. Formal UK modeling requires accurate measures of predialysis and postdialysis blood urea nitrogen levels for the first dialysis treatment of the week, predialysis blood urea nitrogen value for the second dialysis session of the week; predialysis and postdialysis weights, actual hemodialysis treatment time, and effective dialyzer clearance. These values are entered into a computer software program that computes V by a mathematical iteration of two formulas. UK modeling is calculated monthly in the Northwestern Memorial Hospital dialysis unit. Statistical Analysis Between-day coefficients of variation (CVs) for BP- BIA-V and body weight were calculated as SD/mean 100%. Regression analysis and paired t-test were performed to examine the correlation and statistical significance of the mean difference observed in BP-BIA-V with W-V and UK-V. To estimate the suitability of replacing one method (BP-BIA-V) with another (W-V), limits of agreement were determined using the method of Bland and Altman. 4 RESULTS Physical characteristics of study patients and controls are listed in Table 1. Hemodialysis patients were generally older than controls. Mean CV of predialysis body weights over the four sessions was 0.83% 0.42%, with individual variation ranging from 0.36% to 1.6%, suggesting a stable hemodialysis population. This was not significantly different from the CV of 0.50% 0.28% for repeated measures of W-V (individual variation range, 0.17% to 1.08%) and 2.1% 1.28% for repeated measures of BP- BIA-V (individual variation range, 0.84% to 4.45%). In comparison, the CV for UK-V values for the same patients over the preceding 8 months was 13.9% (range, 5.9% to 31.6%). The correlation (r) between BP-BIA-V and W-V was 0.97 for control subjects and 0.93 for hemodialysis patients (Fig 1). Conversely, the correlation between BP-BIA-V and UK-V was poorer (r 0.58) for hemodialysis patients (data not shown). The closeness of agreement between BP-BIA-V and W-V is shown in Bland-Altman plots (Fig 2). For control subjects, the two methods were not significantly different, with BP- BIA-V predicting a mean overestimation (bias) of L compared with W-V. Conversely, BP-BIA consistently overestimated V compared with W-V among hemodialysis patients. The mean bias overestimation was L for women and L for men. DISCUSSION Kinetic modeling is performed to obtain a number that is believed to indicate the dose of dialysis a patient receives. The number is derived from three components: dialyzer clearance, treatment duration, and patient s V. The more precisely we measure clearance, time, and V, the more dependable the number we obtain to indicate the dose of dialysis. Multiple factors have been shown to affect the calculation of UK-V; a single patient may have values that vary from 44% to 123% of body weight in a 7-month period. 5 Therefore, it would be useful if we could predict volume with more certainty, especially if V is being used to help calculate dialysis time. BIA is a potentially useful tool for the measurement of V in the hemodialysis population. BIA has traditionally been performed using the distal tetrapolar electrode placement technique, which requires placement of four gel-impregnated surface electrodes on the foot and ankle and hand and wrist of the right side of the body. Using either single-frequency or multifrequency BIA instruments, V is estimated from the measured impedance along with several anthropometric Table 1. Physical Characteristics of Patients and Controls Patient Males Patient Females Control Males Control Females Age (y) 55 (28-77) 59 (47-73) 42 (32-58) 45 (26-60) Height (cm) ( ) ( ) ( ) ( ) Weight (kg) 76.4 ( ) 63.1 ( ) 90.9 ( ) 65.6 ( ) Weight gain (kg) 3.3 ( ) 3.0 ( ) NOTE. Values are the mean with the range in parentheses.
3 156 KUSHNER AND ROXE Fig 1. Correlation between prediction of W-V and BP-BIA-V for (A) control subjects (r 0.97; P < 0.001) and (B) hemodialysis patients (r 0.93; P 0.02). ( ), Men; (}), women. variables, including height, weight, and sex. Estimation of V and body fat by BIA has been validated in multiple patient populations. 6 However, practical application of the tetrapolar technique poses several problems for the hemodialysis population. These include positional changes in impedance with the change from standing to lying, presence of a fistula or shunt in the arm, and crowded environment of the dialysis unit. 7 BP-BIA offers a new application of BIA technology that may be better suited to the hemodialysis patient population. Impedance and body weight are measured simultaneously, with little need for additional nursing time, training, or expertise. It has the special virtue that a printout of BP-BIA-V is generated with every dialysis session; therefore, 12 values are generated in a typical month. One can average these results in an approximate time-averaged value for V; thus, any unusual circumstance at any given dialysis session will not unduly affect calculations. For estimation of V, BP-BIA avoids consideration of when and how samples for urea reduction ratio are drawn. Another potential advantage of BP- BIA is that it can be performed at home with simultaneous measurement of body weight and body water. Nunez et al 2 have shown that the leg-to-leg system has overall performance char-
4 BIPEDAL BIOELECTRICAL IMPEDANCE AND DIALYSIS 157 Fig 2. Graphical plot of the Bland-Altman representation of the difference between the W-V and BP-BIA-V methods for (A) control subjects and (B) hemodialysis patients. ( ), Men; (}), women. For all controls, mean difference was L; for male patients, L; and for female patients, L. acteristics for impedance measurement similar to conventional arm-to-leg gel electrode BIA. Although BP-BIA-V showed a high correlation with W-V in hemodialysis patients using standard regression analysis (r 0.93), we observed a tendency for BP-BIA to overestimate V compared with W-V in both men and women (Fig 2). This bias may result from bioelectrical changes that occur in renal failure, including alterations in impedance and specific resistance of body fluids and tissues that are dependent on electrolyte concentrations. 7,8 The other likely source of error is the gravity dependence of intradialytic fluid in the lower extremities. The leg-to-leg conduction pathway of BP-BIA thus would overestimate V. The consequence of this error would be to provide more dialysis than might be necessary to achieve a target value for Kt/V. Such increased dialysis may affect postdialysis potassium and other solute values. Because it is not clear whether adequate dialysis is optimal dialysis, this overestimation does not appear to be a practical impediment to the use of BP-BIA-V to estimate V. Although the predictive equation overestimated TBW in hemodialysis patients, there was remarkable intraindi-
5 158 KUSHNER AND ROXE vidual consistency in measurements among dialysis sessions. This reproducibility is an important factor for the dialysis population. In our study, we did not use gold standard methods to measure V, such as deuterium or oxygen. 18 Rather, we compared the level of agreement between BP-BIA-V and W-V. This formula was chosen as a valid comparison because it often is used to predict V in dialysis units and has been shown to provide a reliable estimation of Kt/V compared with the oxygen 18 reference method. 9 The mean CV for predicting W-V (0.50% 0.28%) was very similar to the CV in body weights between dialysis sessions (0.83% 0.42%). This is not surprising because W-V is directly dependent on body weight as the primary predictive variable. If we are to achieve more accurate kinetic modeling, improvement in the methods used to obtain values for clearance, time, or volume is needed. Our data suggest that BP-BIA reproducibly estimates V with a lower CV than UK and avoids the technical problems, costs, and blood draws associated with that method. These advantages facilitate calculations of Kt/V and dialysis time; thus, BP-BIA becomes a preferable method over UK for estimation of V in hemodialysis patients. Nonetheless, we cannot conclude whether BP-BIA-V is superior to W-V because we did not use a gold standard technique and consequently cannot recommend its selected use at this time. Additional studies are needed to explore the causes for overestimation of V compared with W-V. BP-BIA should not be used in patients with pacemakers, defibrillators, or implanted internal or electronic devices until safety concerns are resolved. REFERENCES 1. National Kidney Foundation: DOQI Clinical Practice Guidelines for Hemodialysis Adequacy. New York, NY, National Kidney Foundation, 1997, p Nunez C, Gallegher D, Visser M, Pi-Sunyer FX, Wang Z, Heymfield SB: Bioimpedance analysis: Evaluation of leg-to-leg system based on pressure contact foot-pad electrodes. Med Sci Sports Exerc 29: , Watson PE, Wastson ID, Batt RD: Total body water volumes for adult males and females from simple anthropometric measurements. Am J Clin Nutr 33:27-39, Bland JM, Altman DG: Statistical method for assessing agreement between two methods of clinical measurement. Lancet 1: , Depner TA: Assessing adequacy of hemodialysis: Urea modeling. Kidney Int 45: , Yanorski SZ, Hubbard VS, Heymsfield SB, Lukaski HC (eds): Bioelctrical Impedance Analysis. Proceedings of a National Institutes of Health technology assessment conference. December 12-14, Am J Clin Nutr 64:S387-S532, 1996 (suppl) 7. Kushner RF, de Vries PMJM, Gudivaka R: Use of bioelectrical impedance analysis measurements in the clinical management of patients undergoing dialysis. Am J Clin Nutr 64:S503-S509, 1996 (suppl) 8. Jaeger JQ, Mehta R: Assessment of dry weight in hemodialysis: An overview. J Am Soc Nephrol 10: , Arkouche W, Fouque D, Pachiaudi C, Normand S, Laville M, Delawari E, Riou JP, Traeger J, Laville M: Total body water and body composition in chronic peritoneal dialysis patients. J Am Soc Nephrol 8: , 1997
patients Bioimpedance analysis of total body water in hemodialysis
Kidney International, VoL 46 (1994), pp. 1438 1442 Bioimpedance analysis of total body water in hemodialysis patients L. TAMMY Ho, ROBERT F. KUSHNER, DALE A. SCHOELLER, RANI GuDIvM, and DAVID M. SPIEGEL
More informationSegmental Body Composition Assessment for Obese Japanese Adults by Single-Frequency Bioelectrical Impedance Analysis with 8-point Contact Electrodes
Segmental Body Composition Assessment for Obese Japanese Adults by Single-Frequency Bioelectrical Impedance Analysis with 8-point Contact Electrodes Susumu Sato 1), Shinichi Demura 2), Tamotsu Kitabayashi
More informationThe effect of a meal on measures of impedance and percent body fat estimated using contact-electrode bioelectrical impedance technology
European Journal of Clinical Nutrition (2013) 67, 950 955 & 2013 Macmillan Publishers Limited All rights reserved 0954-3007/13 www.nature.com/ejcn ORIGINAL ARTICLE The effect of a meal on measures of impedance
More informationThere are no shortcuts to Dialysis
There are no shortcuts to Dialysis 1 Outcomes John Sweeny Wednesday, March 21 st, 2018 (3:10 pm 4:10 pm) 2 Quality in Hemodialysis Quality Health Care is the degree to which health services increases the
More informationNATIONAL QUALITY FORUM Renal EM Submitted Measures
NATIONAL QUALITY FORUM Renal EM Submitted Measures Measure ID/ Title Measure Description Measure Steward Topic Area #1662 Percentage of patients aged 18 years and older with a diagnosis of CKD ACE/ARB
More informationSpinal Cord Rehab Program, Toronto Rehabilitation Institute, University Health Network, 520 Sutherland Drive, Toronto, ON, Canada M4G 3V9 2
Journal of Obesity Volume 212, Article ID 936, 9 pages doi:1.11/212/936 Clinical Study Bioelectrical Impedance and Dual-Energy X-Ray Absorptiometry Assessments of Changes in Body Composition Following
More informationAdvances in Peritoneal Dialysis, Vol. 23, 2007
Advances in Peritoneal Dialysis, Vol. 23, 2007 Antonios H. Tzamaloukas, 1,2 Aideloje Onime, 1,2 Dominic S.C. Raj, 2 Glen H. Murata, 1 Dorothy J. VanderJagt, 3 Karen S. Servilla 1,2 Computation of the Dose
More informationPhil. J. Internal Medicine, 47: 19-23, Jan.-Feb., 2009
Original Articles Assessment of Hemodialysis Adequacy 19 Phil. J. Internal Medicine, 47: 19-23, Jan.-Feb., 2009 ASSESSMENT OF HEMODIALYSIS ADEQUACY: IONIC DIALYSANCE IN COMPARISON TO STANDARD METHOD KT/V-MAKATI
More informationPrediction of extracellular water and total body water by multifrequency bio-electrical impedance in a Southeast Asian population
Asia Pacific J Clin Nutr (1999) 8(2): 155 159 155 Original Article OA 88 EN Prediction of extracellular water and total body water by multifrequency bio-electrical impedance in a Southeast Asian population
More informationIN-CENTER HEMODIALYSIS (HD) CLINICAL PERFORMANCE MEASURES DATA COLLECTION FORM 2006
IN-CENTER HEMODIALYSIS (HD) CLINICAL PERFORMANCE MEASURES DATA COLLECTION FORM 2006 PATIENT IDENTIFICATION [Before completing please read instructions at the bottom of this page and on pages 5 and 6] MAKE
More informationSee Your Body BetterTM
Product Brochure 2000 See Your Body BetterTM Products to Track Your Weight and Body Fat % Know Your Weight and Body Fat % Ordinary bathroom scales measure only one thing weight. They can t distinguish
More informationSupplemental Quick Reference Guide
Supplemental Quick Reference Guide How to use this Supplemental Quick Reference Guide This guide provides a 5-step method for considering a variety of frequencies and treatment lengths, based on achieving
More informationTHE ASSESSMENT OF the nutritional status
Estimate of Body Water Compartments and of Body Composition in Maintenance Hemodialysis Patients: Comparison of Single and Multifrequency Bioimpedance Analysis Carlo Donadio, MD, Cristina Consani, BSci,
More informationThe CARI Guidelines Caring for Australians with Renal Impairment. Level of renal function at which to initiate dialysis GUIDELINES
Level of renal function at which to initiate dialysis Date written: September 2004 Final submission: February 2005 GUIDELINES No recommendations possible based on Level I or II evidence SUGGESTIONS FOR
More informationASN DIALYSIS ADVISORY GROUP ASN DIALYSIS CURRICULUM
ASN DIALYSIS ADVISORY GROUP ASN DIALYSIS CURRICULUM Medical Management of Home Hemodialysis Patients Brent W. Miller, MD Professor of Medicine Washington University School of Medicine Saint Louis, Missouri
More informationmean hemoglobin 11 g/dl (110 g/l) compared to patients with lower mean hemoglobin values (Table 20).
S44 Figure 53 depicts the trend in Epoetin dosing from the 1998 study period to the 2003 study period, with an increasing mean weekly Epoetin dose (units/kg/wk) for patients prescribed Epoetin in lower
More informationFAT MASS ESTIMATION BY BIOELECTRICAL IMPEDANCE ANALYSIS
FAT MASS ESTIMATION BY BIOELECTRICAL IMPEDANCE ANALYSIS FAT MASS ESTIMATION BY BIOELECTRICAL IMPEDANCE ANALYSIS Epidemiological studies have shown that relative risk of diabetes and cardiovascular diseases
More informationArticle. The Effect of Racial Origin on Total Body Water Volume in Peritoneal Dialysis Patients
Article The Effect of Racial Origin on Total Body Water Volume in Peritoneal Dialysis Patients Andrew Davenport,* Rabya Hussain Sayed, and Stanley Fan Summary Background and objectives Peritoneal dialysis
More informationPrevalence of Access Recirculation in Prevalent Arterio-Venous (A-V) Fistula Hemodialysis Patients and Its Effect on Hemodialysis Adequacy
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4602-4609 Prevalence of Access Recirculation in Prevalent Arterio-Venous (A-V) Fistula Hemodialysis Patients and Its Effect on Hemodialysis
More informationEffects of Heat Exposure on Body Water Assessed using Single- Frequency Bioelectrical Impedance Analysis and Bioimpedance Spectroscopy
Original Research Effects of Heat Exposure on Body Water Assessed using Single- Frequency Bioelectrical Impedance Analysis and Bioimpedance Spectroscopy BRETT S. NICKERSON 1,2, MICHAEL R. ESCO 2, PHILLIP
More informationSegment-specific resistivity improves body fluid volume estimates from bioimpedance spectroscopy in hemodialysis patients
J Appl Physiol 100: 717 724, 2006. First published October 27, 2005; doi:10.1152/japplphysiol.00669.2005. Segment-specific resistivity improves body fluid volume estimates from bioimpedance spectroscopy
More informationBioelectrical impedance: effect of 3 identical meals on diurnal impedance variation and calculation of body composition 1,2
Bioelectrical impedance: effect of 3 identical meals on diurnal impedance variation and calculation of body composition 1,2 Frode Slinde and Lena Rossander-Hulthén ABSTRACT Background: Bioelectrical impedance
More informationValidation Study of Multi-Frequency Bioelectrical Impedance with Dual-Energy X-ray Absorptiometry Among Obese Patients
OBES SURG (2014) 24:1476 1480 DOI 10.1007/s11695-014-1190-5 OTHER Validation Study of Multi-Frequency Bioelectrical Impedance with Dual-Energy X-ray Absorptiometry Among Obese Patients Silvia L. Faria
More informationThe comparative evaluation of patients body dry weight under hemodialysis using two methods: Bioelectrical impedance analysis and conventional method
Original Article The comparative evaluation of patients body dry weight under hemodialysis using two methods: Bioelectrical impedance analysis and conventional method Neda Alijanian 1, Afsoon Emami Naini
More informationLesson #7: Quality Assessment and Performance Improvement
ESRD Update: Transitioning to New ESRD Conditions for Coverage Student Manual Lesson #7: Quality Assessment and Performance Improvement Learning Objectives At the conclusion of this lesson, you will be
More informationBioimpedance Spectroscopy for the Estimation of Fat-Free Mass In End-Stage Renal Disease
Bioimpedance Spectroscopy for the Estimation of Fat-Free Mass In End-Stage Renal Disease A THESIS SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF THE UNIVERSITY OF MINNESOTA BY Sara M. Vine IN PARTIAL
More informationEvaluation of the Cockroft Gault, Jelliffe and Wright formulae in estimating renal function in elderly cancer patients
Original article Annals of Oncology 15: 291 295, 2004 DOI: 10.1093/annonc/mdh079 Evaluation of the Cockroft Gault, Jelliffe and Wright formulae in estimating renal function in elderly cancer patients G.
More informationValidity of the use of Schwartz formula against creatinine clearance in the assessment of renal functions in children
Validity of the use of Schwartz formula against creatinine clearance in the assessment of renal functions in children *H W Dilanthi 1, G A M Kularatnam 1, S Jayasena 1, E Jasinge 1, D B D L Samaranayake
More informationEvaluation and management of nutrition in children
Evaluation and management of nutrition in children Date written: May 2004 Final submission: January 2005 Author: Elisabeth Hodson GUIDELINES No recommendations possible based on Level I or II evidence
More informationBODY COMPOSITION: AN ANALYSIS BETWEEN THE FOOTBALLER AND THANG-TA PRACTITIONER OF MANIPUR
BODY COMPOSITION: AN ANALYSIS BETWEEN THE FOOTBALLER AND THANG-TA PRACTITIONER OF MANIPUR T. INAOBI SINGH 1, MAIBAM CHOURJIT SINGH 2, CHETAN MAIBAM 3 1 Department of Physical Education & Sports Science,
More informationEstimating Total Body Water in Children on the Basis of Height and Weight: A Reevaluation of the Formulas of Mellits and Cheek
J Am Soc Nephrol 13: 1884 1888, 2002 Estimating Total Body Water in Children on the Basis of Height and Weight: A Reevaluation of the Formulas of Mellits and Cheek BRUCE Z. MORGENSTERN,* DOUGLAS W. MAHONEY,
More informationDialysis Dose Prescription and Delivery. William Clark, M.D. Claudio Ronco, M.D. Rolando Claure-Del Granado, M.D. CRRT Conference February 15, 2012
Dialysis Dose Prescription and Delivery William Clark, M.D. Claudio Ronco, M.D. Rolando Claure-Del Granado, M.D. CRRT Conference February 15, 2012 Dose in RRT: Key concepts Dose definition Quantifying
More informationHemodialysis is a life-sustaining procedure for the treatment of
The Dialysis Prescription and Urea Modeling Biff F. Palmer Hemodialysis is a life-sustaining procedure for the treatment of patients with end-stage renal disease. In acute renal failure the procedure provides
More informationMEASUREMENT OF BODY COMPOSITION BY IMPEDENCEMETRY NUTRITION CENTRES
Page 1 of 8 1. Scope This procedure is to be followed by the ECRIN Nutrition Centres when performing measurements of body composition by indpendencemetry This procedure describes the steps necessary to
More informationThere are 4 user settings that store the memory of personal parameters for ease of continued use.
INTRODUCTION Thank you for choosing the Healthy Balance Electronic Body Fat Scale. For proper usage of this device please read the following instructions carefully. Using the latest BIA (Bioelectrical
More informationAssessment of glomerular filtration rate in healthy subjects and normoalbuminuric diabetic patients: validity of a new (MDRD) prediction equation
Nephrol Dial Transplant (2002) 17: 1909 1913 Original Article Assessment of glomerular filtration rate in healthy subjects and normoalbuminuric diabetic patients: validity of a new () prediction equation
More informationThe Egyptian Journal of Hospital Medicine (October 2017) Vol.69(1), Page
The Egyptian Journal of Hospital Medicine (October 2017) Vol.69(1), Page 1589-1594 Using Serum Beta Trace Protein to Estimate Residual Kidney Function in Hemodialysis Patients Hesham M. El-Sayed, Hussein
More informationBioimpedance in medicine: Measuring hydration influence
Journal of Physics: Conference Series Bioimpedance in medicine: Measuring hydration influence To cite this article: J Hlubik et al 0 J. Phys.: Conf. Ser. 0 View the article online for updates and enhancements.
More informationESPEN Congress The Hague 2017
ESPEN Congress The Hague 2017 Paediatric specificities of nutritional assessment Body composition measurement in children N. Mehta (US) 39 th ESPEN Congress The Hague, Netherlands Body Composition Measurement
More informationThe measurement of blood access flow rate (Qa; ml/min)
Hemodialysis Blood Access Flow Rates Can Be Estimated Accurately from On-Line Dialysate Urea Measurements and the Knowledge of Effective Dialyzer Urea Clearance Robert M. Lindsay,* Jan Sternby, Bo Olde,
More informationIN-CENTER HEMODIALYSIS (HD) CLINICAL PERFORMANCE MEASURES DATA COLLECTION FORM 2001
IN-CENTER HEMODIALYSIS (HD) CLINICAL PERFORMANCE MEASURES DATA COLLECTION FORM 2001 [Before completing please read instructions at the bottom of this page and on pages 4 and 5] PATIENT IDENTIFICATION MAKE
More informationFOUR. Clinical Indicators of Care
Clinical Indicators of Care T FOUR The great questions of the time are not decided by speeches and majority decisions but by iron and blood. Otto von Bismarck, Speech to the Prussian Diet 78 ž 2000 ATLAS
More informationMETABOLISM AND NUTRITION WITH PD OBESITY. Rajnish Mehrotra Harborview Medical Center University of Washington, Seattle
METABOLISM AND NUTRITION WITH PD OBESITY Rajnish Mehrotra Harborview Medical Center University of Washington, Seattle 1 Body Size in Patients New to Dialysis United States Body Mass Index, kg/m2 33 31
More informationCRRT for the Experience User 1. Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference March, 2018
CRRT for the Experience User 1 Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference March, 2018 Disclosures I have no actual or potential conflict of interest
More informationbioelectrical impedance measurements. Aviation Space and Environmental Medicine, 59,
MS ID: 9761874491197639 Authors: Macias et al Title: Body fat measurement by bioelectrical impedance versus air displacement plethysmography: a validation to design bioelectrical impedance equations in
More informationThe CARI Guidelines Caring for Australians with Renal Impairment. Other criteria for starting dialysis GUIDELINES
Date written: September 2004 Final submission: February 2005 Other criteria for starting dialysis GUIDELINES No recommendations possible based on Level I or II evidence SUGGESTIONS FOR CLINICAL CARE (Suggestions
More informationIn-Center Hemodialysis Six Times per Week versus Three Times per Week
Journal Club du 25 novembre 2010 In-Center Hemodialysis Six Times per Week versus Three Times per Week The FHN Trial Group N Engl J Med 2010 Frequent Hemodialysis Network Introduction fréquence? dose?
More informationThe CARI Guidelines Caring for Australians with Renal Impairment. Monitoring patients on peritoneal dialysis GUIDELINES
Date written: August 2004 Final submission: July 2005 Monitoring patients on peritoneal dialysis GUIDELINES No recommendations possible based on Level I or II evidence SUGGESTIONS FOR CLINICAL CARE (Suggestions
More informationGeriatric Nutritional Risk Index, home hemodialysis outcomes 131
Subject Index Aksys PHD system 113 Anemia, home outcomes 111, 172, 173 Automated peritoneal dialysis dialysis comparison 17, 18 selection factors 18, 19 telemedicine system 19 21 Blood pressure -peritoneal
More informationOverview of the FITNESSGRAM Body Composition Standards
body composition Body composition refers to the division of total body weight (mass) into components, most commonly fat mass and fat-free mass. The proportion of total body weight that is fat (referred
More informationMEASURE INFORMATION FORM
MEASURE INFORMATION FORM Project Title: Comprehensive Reevaluation Dialysis Adequacy Project Overview: The Centers for Medicare & Medicaid Services (CMS) has contracted with the University of Michigan
More informationIN THE NAME OF GOD Uremic toxins I. Small (< 500 D); water soluble Surrogate marker urea or sodium (ionic dialysance) Rapidly produced in intracellular fluid compartment Large variability in intra-patient
More informationDiagnostics Assessment Report (DAR) - Comments
Diagnostics Assessment Report (DAR) - s 1 3 Results The comment The results of the meta-analyses conducted for this assessment showed that using the BCM - Body Composition Monitor, as compared with standard
More informationEffect of Physical Training on Body Composition in Moscow Adolescents
Effect of Physical Training on Body Composition in Moscow Adolescents Elena Godina, Irena Khomyakova, Arsen Purundzhan, Anna Tretyak and Ludmila Zadorozhnaya Institute and Museum of Anthropology, Moscow
More informationVector length as a proxy for the adequacy of ultrafiltration in hemodialysis
Kidney International, Vol. 66 (24), pp. 1266 1271 Vector length as a proxy for the adequacy of ultrafiltration in hemodialysis LUANA PILLON, ANTONIO PICCOLI, EMU G. LOWRIE, J. MICHAEL LAZARUS, and GLENN
More informationBody Fat Monitor / Scale Model: UM-040/041 Instruction Manual
Body Fat Monitor / Scale Model: UM-040/041 Instruction Manual Read this Instruction Manual carefully and keep it for future reference. Table of Contents Introduction...1 Principles of estimating body fat
More informationThe Influence of Posture Change on Measurements of Relative Body Fat in the Bioimpedance Analysis Method
Original Journal of PHYSIOLOGICAL ANTHROPOLOGY and Applied Human Science The Influence of Posture Change on Measurements of Relative Body Fat in the Bioimpedance Analysis Method Shinichi Demura 1), Shunsuke
More informationPrincipal Equations of Dialysis. John A. Sweeny
Principal Equations of Dialysis John A. Sweeny john@sweenyfamily.net 1 An Equation is Math: A statement that each of two statements are equal to each other. Y 2 = 3x 3 + 2x + 7 Chemistry: A symbolic expression
More informationQUANTUM. Body Composition Scale. 396lb x 0.2lb 180kg x 0.1kg
QUANTUM Body Composition Scale 396lb x 0.2lb 180kg x 0.1kg Quantum Manual Thank you for purchasing the American Weigh Quantum Body Composition Scale. Please read all operating instructions carefully before
More informationNKF-DOQI CLINICAL PRACTICE GUIDELINES FOR HEMODIALYSIS ADEQUACY
NKF-DOQI CLINICAL PRACTICE GUIDELINES FOR HEMODIALYSIS ADEQUACY 515 Acronyms and Abbreviations Abbreviation AAMI BUN EDW ESRD GFR HCFA HD HEMO NCDS NPCR PRU QALE RPA TCV TMP UFR UKM URR USRDS Term Association
More informationCOMPARISON OF AIR DISPLACEMENT PLETHYSMOGRAPHY TO HYDROSTATIC WEIGHING FOR ESTIMATING TOTAL BODY DENSITY IN CHILDREN
COMPARISON OF AIR DISPLACEMENT PLETHYSMOGRAPHY TO HYDROSTATIC WEIGHING FOR ESTIMATING TOTAL BODY DENSITY IN CHILDREN Geo Claros 1, Holly R Hull 1, and David A Fields 1,2 * 1 Department of Health and Exercise
More informationYasushi Ohashi, MD, Takatoshi Otani, MD, Reibin Tai, MD, Yoshihide Tanaka, MD, Ken Sakai, MD, PhD, and Atsushi Aikawa, MD, PhD
RESEARCH BRIEF Assessment of Body Composition Using Dry Mass Index and Ratio of Total Body Water to Estimated Volume Based on Bioelectrical Impedance Analysis in Chronic Kidney Disease Patients Yasushi
More informationTABLE OF CONTENTS T-1. A-1 Acronyms and Abbreviations. S-1 Stages of Chronic Kidney Disease (CKD)
A-1 Acronyms and Abbreviations TABLE OF CONTENTS S-1 Stages of Chronic Kidney Disease (CKD) Chapter 1: Nutrition Assessment Charts, Tables and Formulas 1-2 Practical Steps to Nutrition Assessment Adult
More informationPVDOMICS: ECG Training
PVDOMICS: ECG Training Cardiovascular Physiology Core Cleveland Clinic, Cleveland OH March 16, 2018 NHLBI Pulmonary Vascular Disease Phenomics Program Funded by the National Heart, Lung, and Blood Institute
More informationEvaluation of two foot-to-foot bioelectrical impedance analysers to assess body composition in overweight and obese adolescents
British Journal of Nutrition (2003), 90, 987 992 q The Authors 2003 DOI: 10.1079/BJN2003983 Evaluation of two foot-to-foot bioelectrical impedance analysers to assess body composition in overweight and
More information1. Frequently asked questions
1. Frequently asked questions Q. How is BMR calculated by boditrax composition monitors? The electrical signals do not directly measure BMR. They measure electrical impedance, and from this, the weight
More informationMeasurement of Total RBC Volume Relative to Lean Body Mass for Diagnosis of Polycythemia
Hematopathology / TOTAL RBC VOLUME AND BODY FAT Measurement of Total RBC Volume Relative to Lean Body Mass for Diagnosis of Polycythemia Nathaniel I. Berlin, MD, 1 and S. Mitchell Lewis, MD 2 Key Words:
More informationMeasurement of Total RBC Volume Relative to Lean Body Mass for Diagnosis of Polycythemia
Hematopathology / TOTAL RBC VOLUME AND BODY FAT Measurement of Total RBC Volume Relative to Lean Body Mass for Diagnosis of Polycythemia Nathaniel I. Berlin, MD, 1 and S. Mitchell Lewis, MD 2 Key Words:
More informationUnit 1: Fitness for Sport and Exercise. Fitness Testing
Unit 1: Fitness for Sport and Exercise Fitness Testing Importance of fitness testing Gives baseline data for monitoring/improving performance Can design training programmes based on test results and determine
More informationCurrent Voltage characteristic of biological tissue: Body resistance
6_Current Voltage characteristic of biological tissue.xlsx/work procedure Study group: Year of study: Current Voltage characteristic of biological tissue: Body resistance Objective: Establish the mean
More informationTHE HEMODIALYSIS PRESCRIPTION: TREATMENT ADEQUACY GERALD SCHULMAN MD VANDERBILT UNIVERSITY MEDICAL SCHOOL NASHVILLE, TENNESSEE
THE HEMODIALYSIS PRESCRIPTION: TREATMENT ADEQUACY GERALD SCHULMAN MD VANDERBILT UNIVERSITY MEDICAL SCHOOL NASHVILLE, TENNESSEE THE DIALYSIS CYCLE /TIME DESIGN OF THE NATIONAL COOPERATIVE DIALYSIS STUDY
More informationAchieving Equilibrium in ESRD Patients
Achieving Equilibrium in ESRD Patients -Marc Richards MD -South Florida Kidney Disease and HTN Specialists -Chief of Medicine, BRRH -BRRH Grand Rounds: April 18 th, 2017 Outline Dialysis prescription Adequacy
More informationClinical judgment is the most important element in overhydration assessment of chronic hemodialysis patients
Clin Exp Nephrol (2013) 17:563 568 DOI 10.1007/s10157-012-0745-9 ORIGINAL ARTICLE Clinical judgment is the most important element in overhydration assessment of chronic hemodialysis patients Radovan Vasko
More informationQuick Start Guide for the BIA 450
Quick Start Guide for the BIA 450 Copyright 2004-2017 Biodynamics Corporation All Rights Reserved Table of Contents 1. General Theory... 1 2. Conducting a Test... 4 3. Patient Preparation... 5 4. Precautions...
More informationAdequacy of haemodialysis and nutrition in maintenance haemodialysis patients: clinical evaluation of a new on-line urea monitor
Nephrol Dial Transplant (1996) 11: 1568-1573 Original Article IMephrology Dialysis Transplantation Adequacy of haemodialysis and nutrition in maintenance haemodialysis patients: clinical evaluation of
More informationAnthropometric Prediction of Total Body Water in Children Who Are on Pediatric Peritoneal Dialysis
Anthropometric Prediction of Total Body Water in Children Who Are on Pediatric Peritoneal Dialysis Bruce Z. Morgenstern,* Elke Wühl, K. Sreekumaran Nair, Bradley A. Warady, and Franz Schaefer *Division
More informationAssessment of body composition of Sri Lankan Australian children using ethnic specific equations
J.Natn.Sci.Foundation Sri Lanka 2015 43 (2): 111-118 DOI: http://dx.doi.org/10.4038/jnsfsr.v43i2.7938 RESEARCH ARTICLE Assessment of body composition of Sri Lankan Australian children using ethnic specific
More informationEstimation of total-body and limb muscle mass in hemodialysis patients by using multifrequency bioimpedance spectroscopy 1 3
Estimation of total-body and limb muscle mass in hemodialysis patients by using multifrequency bioimpedance spectroscopy 1 3 George A Kaysen, Fansan Zhu, Shubho Sarkar, Steven B Heymsfield, Jack Wong,
More informationPERITONEAL DIALYSIS PRESCRIPTION MANAGEMENT GUIDE
PERITONEAL DIALYSIS PRESCRIPTION MANAGEMENT GUIDE TABLE OF CONTENTS Introduction.... 3 SECTION 1: FUNDAMENTALS OF THE PRESCRIPTION.... 4 Getting Started: Patient Pathway to First Prescription.... 5 Volume
More informationValidation of bioimpedance body composition assessment by TANITA BC-418 in 7 years-
Validation of bioimpedance body composition assessment by TANITA BC-418 in 7 years- old children vs. Dual X-ray absorptiometry Veronica Luque on behalf to URV Team 18th November 2012 Milano, 10th Bi-annual
More informationQuick Start Guide for the BIA 310e
Quick Start Guide for the BIA 310e Copyright 2004-2017 Biodynamics Corporation All Rights Reserved Table of Contents 1. General Theory... 1 2. Conducting a Test... 3 3. Subject Preparation... 4 4. Precautions...
More informationEXTRACELLULAR WATER REFERENCE VALUES. Extracellular Water: Reference values for Adults
CHAPTER 5 Extracellular Water: Reference values for Adults Analiza M. Silva, Jack Wang, Richard N. Pierson Jr., ZiMian Wang, David B. Allison Steven B. Heymsfield, Luis B. Sardinha, Stanley Heshka ABSTRACT
More informationDevelopment of Regression Equation for the Measurement of Visceral Fat Area using Bioimpedance Technique
Development of Regression Equation for the Measurement of Visceral Fat 10.5005/jp-journals-10036-1080 Area using Bioimpedance Technique ORIGINAL ARTICLE Development of Regression Equation for the Measurement
More informationKt/V underestimates the hemodialysis dose in women and small men
original article http://www.kidney-international.org & 8 International Society of Nephrology see commentary on page 262 Kt/V underestimates the hemodialysis dose in women and small men Elaine M. Spalding
More informationlntertester and lntratester Reliability of a Dynamic Balance Protocol Using the Biodex Stability System
Journal of Sport Rehabilitation, 1998, 7, 95-101 0 1998 Human Kinetics Publishers, Inc. lntertester and lntratester Reliability of a Dynamic Balance Protocol Using the Biodex Stability System Randy Schmitz
More informationCJASN epress. Published on July 1, 2010 as doi: /CJN
CJASN epress. Published on July 1, 2010 as doi: 10.2215/CJN.02350310 Can Rescaling Dose of Dialysis to Body Surface Area in the HEMO Study Explain the Different Responses to Dose in Women versus Men? John
More informationCreatinine index and lean body mass are excellent predictors of long-term survival in haemodiafiltration patients
Nephrol Dial Transplant (2004) 19: 1182 1189 DOI: 10.1093/ndt/gfh016 Advance Access publication 19 February 2004 Original Article Creatinine index and lean body mass are excellent predictors of long-term
More informationHaemodialysis. Online Clearance Monitoring Assuring the Desired Dose of Dialysis
Haemodialysis Online Clearance Monitoring Assuring the Desired Dose of Dialysis Contents 1. Foreword 2. Dialysis dose 2.1 Standard methods of determination of the dialysis dose 2.1.1 Urea Reduction Ratio
More informationObjectives. Peritoneal Dialysis vs. Hemodialysis 02/27/2018. Peritoneal Dialysis Prescription and Adequacy Monitoring
Peritoneal Dialysis Prescription and Adequacy Monitoring Christine B. Sethna, MD, EdM Division Director, Pediatric Nephrology Cohen Children s Medical Center Associate Professor Hofstra Northwell School
More informationPERITONEAL DIALYSIS PRESCRIPTION MANAGEMENT QUICK REFERENCE GUIDE
PERITONEAL DIALYSIS PRESCRIPTION MANAGEMENT QUICK REFERENCE GUIDE This quick reference guide will help serve as a reference tool for clinicians setting a patient s Peritoneal Dialysis (PD) prescription.
More informationSpecific Basic Standards for Osteopathic Fellowship Training in Nephrology
Specific Basic Standards for Osteopathic Fellowship Training in Nephrology American Osteopathic Association and American College of Osteopathic Internists BOT Rev. 2/2011 These specific basic standards
More information02/21/2017. Assessment of the Peritoneal Membrane: Practice Workshop. Objectives. Review of Physiology. Marina Villano, MSN, RN, CNN
Assessment of the Peritoneal Membrane: Practice Workshop Marina Villano, MSN, RN, CNN marina.villano@fmc-na.com Objectives Briefly review normal peritoneal physiology including the three pore model. Compare
More informationChapter 2 Peritoneal Equilibration Testing and Application
Chapter 2 Peritoneal Equilibration Testing and Application Francisco J. Cano Case Presentation FW, a recently diagnosed patient with CKD Stage 5, is a 6-year-old boy who has been recommended to initiate
More informationDATE: 25 August 2015 CONTEXT AND POLICY ISSUES
TITLE: Bioimpedance Devices for the Assessment of Body Fluid Volume for Patients Undergoing Dialysis: A Review of the Clinical Effectiveness, Cost-Effectiveness and Guidelines An Update DATE: 25 August
More informationCompetitor Series. Body Composition Analyzers
Competitor Series Body Composition Analyzers Right Arm Bringing it All Together. Giving You the Advantage. Right Leg Trunk Left Arm Rice Lake s Competitor Series body composition analyzers (BCA) are designed
More informationDevelopment of Bio-impedance Analyzer (BIA) for Body Fat Calculation
IOP Conference Series: Materials Science and Engineering PAPER OPEN ACCESS Development of Bio-impedance Analyzer (BIA) for Body Fat Calculation Recent citations - Munawar A Riyadi et al To cite this article:
More informationPART ONE. Peritoneal Kinetics and Anatomy
PART ONE Peritoneal Kinetics and Anatomy Advances in Peritoneal Dialysis, Vol. 22, 2006 Paul A. Fein, Irfan Fazil, Muhammad A. Rafiq, Teresa Schloth, Betty Matza, Jyotiprakas Chattopadhyay, Morrell M.
More informationChapter 7: Adequacy of Haemodialysis and Serum Bicarbonate
Chapter 7: Adequacy of Haemodialysis and Serum Bicarbonate Summary. The urea reduction ratio (URR) has been rising year on year but now appears to have reached a plateau.. The URR increases the longer
More informationINSPIRED BY LIFE B. BRAUN DIALYZERS
INSPIRED BY LIFE B. BRAUN DIALYZERS OUR COMMITMENT. FOR LIFE. The Diacap Pro and xevonta dialyzers offer a broad range of high-quality dialyzers for individual treatment needs. It began in 1839, inspired
More informationQuality ID #329: Adult Kidney Disease: Catheter Use at Initiation of Hemodialysis National Quality Strategy Domain: Effective Clinical Care
Quality ID #329: Adult Kidney Disease: Catheter Use at Initiation of Hemodialysis National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE:
More information