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Fluid balance assessment in pediatric hemodialysis patients by using whole-body bioimpedance spectroscopy (WB-BIS)

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Abstract

Background

Fluid overload is a major factor in morbidity and mortality in dialysis patients. Whole-body bioimpedance spectroscopy (WB-BIS) is a noninvasive method for assessing fluid status. We hypothesized that fluid status measurement of changes in total body water (TBW), extracellular fluid (ECF), and intracellular fluid (ICF) by WB-BIS would correlate with the weight (Wt) changes before and after hemodialysis (HD) and the amount of ultrafiltration (UF) in pediatric HD patients. We also examined the relationship between the ECF percent of total body water (ECF%) and ECF/ICF ratio with the pre-HD systolic blood pressure percentile (SBP%ile).

Methods

WB-BIS measurements were made both before and after HD on three separate occasions in each patient. Pre- and post-HD Wt, BP, and UF volumes were collected on the day of BIS measurement.

Results

At total of 96 measurements were obtained from 16 HD patients. There were 6 females (mean age: 13.2 ± 4.5 yrs). UF correlated with changes in weight, TBW and ECF (p < 0.001) but not with ICF changes (p = 0.345). Pre-HD SBP%ile correlated with ECF%.

Conclusions

Our findings suggest that WB-BIS can be used to monitor the fluid status in pediatric HD patients. The fluid that is removed from the patient during the HD treatment primarily comes from the ECF and not the ICF. Mobilization of fluid from the ICF appears to be delayed. Patients with significantly higher pre-HD ECF% and ECF/ICF ratio had higher pre-HD systolic BP.

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Acknowledgements

We are grateful to Dr. Zuber D. Mulla, assistant dean, office of faculty development from Texas Tech University Health Sciences Center El Paso, El Paso, Texas, for his advice on statistical test and Ms. Tin Khine, business analyst and biostatical consultant from University of Texas Southwestern Medical Center, Dallas, Texas, for BIS data download and processing.

Funding

Internal departmental funding.

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Authors and Affiliations

  1. Children’s Medical Center, Dallas, TX, USA

    Ei E. Khin, Ayah Y. Elmaghrabi & Raymond Quigley

  2. UT-Southwestern Medical Center, Dallas, TX, 75390, USA

    Ei E. Khin, Ayah Y. Elmaghrabi & Raymond Quigley

  3. Texas Tech University Health Science Center El Paso, El Paso, TX, USA

    Ei E. Khin & Luis A. Alvarado

  4. Cook’s Children’s Hospital, Fort Worth, TX, USA

    Vinai Modem

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  1. Ei E. Khin
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Correspondence to Raymond Quigley.

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Khin, E.E., Elmaghrabi, A.Y., Alvarado, L.A. et al. Fluid balance assessment in pediatric hemodialysis patients by using whole-body bioimpedance spectroscopy (WB-BIS). Pediatr Nephrol 37, 2449–2456 (2022). https://doi.org/10.1007/s00467-022-05469-6

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