Bioelectrical Impedance Vector Analysis for Assessment of Hydration in Physiological States and Clinical Conditions

  • Henry C. Lukaski
  • Antonio Piccoli


Although the importance of assessing hydration is well recognized, traditional laboratory methods and clinical impressions are impractical or lack sensitivity to be useful in physiological and clinical conditions. Alternate approaches using bioelectrical impedance measurements to estimate fluid volumes utilize regression equations and depend on physical models unproven in physiological systems; they result in large errors in the prediction of fluid volumes notably in individuals with altered hydration. Bioelectrical impedance vector analysis (BIVA) overcomes these limitations because it only uses determinations of resistance (R) and reactance (Xc) normalized for height and yields a vector of specific magnitude (length) and direction (phase angle). This vector, for either an individual or a group, is evaluated on the bivariate RXc graph, which is a probability distribution derived from a reference population of healthy, matched controls. Comparison of an individual or group vector to the mean vector of the reference population provides reliable and accurate classification and ranking of hydration that is independent of body weight. Applications of BIVA in healthy adults include assessment of over-hydration in pregnancy and weight loss in obesity. BIVA also has broad uses in the evaluation and management of clinical groups including the characterization of patterns of hydration change during hemodialysis (HD) and peritoneal dialysis and use of this information to prescribe dialytic therapy; identification of under-hydration in critically ill patients and guidance for administration of fluid therapy; assessment and monitoring of tissue hydration status in congestive heart failure; and identification of regional edema in patients after vascular surgery. Because of its practicality and reliability, BIVA can be used in observational and longitudinal studies of hydration in patient care and management and in field conditions.


Obesity Migration Catheter Anisotropy Hydration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Bioelectrical impedance analysis


Bioelectrical impedance spectroscopy


Bioelectrical impedance vector analysis


Chronic ambulatory peritoneal dialysis


Central venous pressure


Extracellular water


Extracellular water/intracellular water


Standing height




Intensive care unit


Intracellular water




pro-BNP N-terminal pro-B-type natriuretic peptide


Phase angle


Peritoneal dialysis




Total body water








  1. Armstrong LE. J Am Coll Nutr. 2007;26:575S–84S.PubMedGoogle Scholar
  2. Bosy-Westphal A, Danielzik D, Dörhöfer R-P, Piccoli A, Müller MJ. Am J Clin Nutr. 2005;82:60–8.PubMedGoogle Scholar
  3. Buchholz AC, Bartok C, Schoeller DA. Nutr Clin Pract. 2004;19:433–46.PubMedCrossRefGoogle Scholar
  4. Chumlea WC, Guo SS, Kuczmarski RJ, Flegal KM, Johnson CL, Heymsfield SB, Lukaski HC, Friedl K, Hubbard VS. Int J Obes. 2002;26:1596–609.CrossRefGoogle Scholar
  5. Codognotto M, Piazza M, Frigatti P, Piccoli A. Nutrition. 2008;24:569–74.PubMedCrossRefGoogle Scholar
  6. De Lorenzo A, Andreoli A, Matthie J, Withers P. J Appl Physiol. 1997;82:1542–58.PubMedGoogle Scholar
  7. Earthman C, Traughber D, Dobratz J, Howell W. Nutr Clin Pract. 2007;22:389–405.PubMedCrossRefGoogle Scholar
  8. Edelman IS, Leibman J. Am J Med. 1959;27:256–77.PubMedCrossRefGoogle Scholar
  9. Guida B, De Nicola L, Trio R, Pecoraro P, Iodice C, Memoli B. Am J Nephrol. 2000;20:311–8.PubMedCrossRefGoogle Scholar
  10. Jaffrin MY, Morel H. Med Eng Phys. 2008;30:1257–69.PubMedCrossRefGoogle Scholar
  11. Kavouras SA. Curr Opin Clin Nutr Metab Care. 2002;5:519–24.PubMedCrossRefGoogle Scholar
  12. Kyle UG, Bosaeus I, De Lorenzo AD, Geurenberg P, Elia M, Gomex JM, Heitmann BL, Kent-Smith L, Melchior J-C, Pirlich M, Scharfetter H, Schols AMWJ, Pichard C. Clin Nutr. 2004;23:1430–53.PubMedCrossRefGoogle Scholar
  13. Lukaski HC. Am J Clin Nutr. 1996;64:397S–404S.PubMedGoogle Scholar
  14. Lukaski HC, Hall CB, Siders WA. Nutrition. 2007;23:543–50.PubMedCrossRefGoogle Scholar
  15. Manz F. J Am Coll Nutr. 2007;26:535S–41S.PubMedGoogle Scholar
  16. Piccoli A. Kidney Int. 1998;53:1036–43.PubMedCrossRefGoogle Scholar
  17. Piccoli A. Kidney Int. 2004;65:1050–63.PubMedCrossRefGoogle Scholar
  18. Piccoli A. Contrib Nephrol. 2005;149:150–61.PubMedCrossRefGoogle Scholar
  19. Piccoli A, Codognotto M. Kidney Int. 2004;66 2091–2.PubMedCrossRefGoogle Scholar
  20. Piccoli A, Rossi B, Pillon L, Bucciante G. Kidney Int. 1994;46:534–53.PubMedCrossRefGoogle Scholar
  21. Piccoli A, Nigrelli S, Caberlotto A, Bottazzo S, Rossi B, Pillon L, Maggiore Q. Am J Clin Nutr. 1995;61:269–70.PubMedGoogle Scholar
  22. Piccoli A, Brunani A, Savia G, Pillon L, Favaro E, Berselli ME, Cavagnini F. Int J Obesity. 1998;22:97–104.CrossRefGoogle Scholar
  23. Piccoli A, Pittoni G, Facco E, Favaro E, Pillon L. Crit Care Med. 2000;28:132–7.PubMedCrossRefGoogle Scholar
  24. Piccoli A, Pillon L, Dumler F. Nutrition. 2002;18:153–67.PubMedCrossRefGoogle Scholar
  25. Piccoli A, Pastori G, Guizzo M, Rebeschini M, Naso A, Cascone C. Kidney Int. 2005;67:301–13.PubMedCrossRefGoogle Scholar
  26. Pillon L, Piccoli A, Lowrie EG, Lazarus JM, Chertow GM. Kidney Int. 2004;66:1266–71.PubMedCrossRefGoogle Scholar
  27. Sun SS, Chumlea WC, Heymsfield SB, Lukaski HC, Schoeller D, Friedl K, Kuczmarski RJ, Flegal KM, Johnson CL. Am J Clin Nutr. 2003;77:331–40.PubMedGoogle Scholar
  28. Ward LC, Elia M, Cornish BH. Physiol Meas. 1998;19:53–60.PubMedCrossRefGoogle Scholar
  29. Van Marken Lichtenbelt WD, Fogelholm M. J Appl Physiol. 1999;87:294–8.Google Scholar
  30. Waki M, Kral JG, Mazariegos M, Wang J, Pierson RN, Heymsfield SB. Am J Physiol. 1991;261:E199–E2003.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Physical Education, Exercise Science and WellnessUniversity of North DakotaGrand ForksUSA

Personalised recommendations