Volume and Body Composition in Hemodialysis Patients: A Bioimpedance Study Assessing Differences by Sex

• DOI: 10.1016/j.xkme.2024.100837
• Publication Date: 2024-05-16T17:48:27Z
• Authors: Sebastian Mussnig; Janosch Niknam; Christoph Matthias; Susanne Widmer; Dilara Gülmez; Simon Krenn; Matthias Lorenz; Charles Chazot; Peter Wabel; Daniel Schneditz; Manfred Hecking
• Keywords: Research Letter; RC870-923; Diseases of the genitourinary system. Urology

Individuals with kidney disease receiving maintenance hemodialysis exhibit improved survival higher baseline body mass index and weight gain over time (1Kalantar-Zadeh K. Kopple J.D. Kilpatrick R.D. McAllister C.J. Shinaberger C.S. Gjertson D.W. et al.Association of Morbid Obesity Weight Change Over Time With Cardiovascular Survival in Hemodialysis Population.Am J Kidney Dis. 2005 Sep; 46: 489-500Abstract Full Text PDF PubMed Scopus (253) Google Scholar). This reversal risk factors compared to the general population (often misnamed "reverse epidemiology" (2Levin N.W. Handelman G.J. Coresh J. Port F.K. Kaysen G.A. Reverse Epidemiology: A Confusing, Confounding, Inaccurate Term.Semin Dial. 2007 Nov; 20: 586-592Crossref (64) Scholar)) has been substantiated by metrics composition obtained through bioimpedance spectroscopy. Specifically, bioimpedance-spectroscopy-data have indicated was optimal pre-dialysis lean tissue (LTI) ranging from 15-20kg/m2 fat (FTI) 4-15kg/m2, respectively (3Marcelli D. Usvyat L.A. Kotanko P. Bayh I. Canaud B. Etter M. al.Body dialysis patients: results an international cohort study.Clin Am Soc Nephrol CJASN. 2015 Jul 7; 10: 1192-1200Crossref (0) Bioimpedance-derived estimates fluid status are also associated increased mortality when exceeding 2.5L absolute volume overload (VO) 15% relative VO as a percentage extracellular water (4Wizemann V. Wabel Chamney Zaluska W. Moissl U. Rode C. al.The overhydration haemodialysis patients.Nephrol Dial Transplant Off Publ Eur Transpl Assoc - Ren Assoc. 2009 May; 24: 1574-1579Crossref Although reference individuals for LTI FTI were age- sex-matched (5Wieskotten S. Heinke Becker Pirlich al.Bioimpedance-based identification malnutrition using fuzzy logic.Physiol Meas. 2008 May 1; 29: 639-654Crossref (62) Scholar), those not In light current efforts better understand sex discrepancies patients (6Chesnaye N.C. Carrero J.J. Hecking Jager K.J. Differences epidemiology, management outcomes men women.Nat Rev Nephrol. 2024 Jan; 7-20Crossref (7) we aimed explore whether there differences between male female on hemodialysis. We retrospectively analyzed measurements conducted November 2022 January 2023 at "Vienna Dialysis-Center" (a tertiary care facility Vienna, Austria). Patients measured Body Composition Monitor (Fresenius Medical Care) Cella (Cella Medical) spectroscopy devices standard wrist-to-ankle setups pre-gelled electrodes. Detailed methodology further provided Item S1-S2. 2022, Vienna Dialysis-Center cared 304 (285 regular twice- or thrice-weekly hemodialysis, 11 undergoing in-hospital treatment, 8 vacation). Pre-dialysis data 159 available initial evaluation. After excluding erroneous (Fig S1), 137 remained comparisons, 85 (62.0%) whom 52 (38.0%) female. Study shown overall stratified Table 1. (higher males), males) females) differed significantly sexes while did not. The proportion within (the range survival) males females (27.1% vs. 7.7%, p<0.01), but no difference above-mentioned thresholds 1 Fig S2). all parameters (Table S1 S3-S7).Table 1General data, therapy study sexCharacteristicMissing (n, %)Overall, n = 137Male, 85Female, 52PPopulation characteristicsAge, years0 (0%)63.0 (52.0, 74.0)60.0 (48.0, 72.0)65.5 (57.8, 75.3)0.08 †Height, cm0 (0%)170.0 (162.0, 176.0)174.0 (170.0, 180.0)160.0 (157.0, 164.3)<0.01 †Body index, kg/m20 (0%)26.6 (23.2, 31.1)26.5 (23.3, 30.6)27.1 (22.4, 33.3)0.6 pre-HD, kg2 (1.5%)78.3 (67.1, 89.6)80.8 (69.6, 94.4)72.7 (63.3, 86.6)<0.01 †Intradialytic loss, kg5 (3.6%)2.4 (1.3, 3.0)2.5 (1.8, 3.3)2.0 (1.1, 2.5)<0.01 †Difference dry post-HD, kg10 (7.3%)0.1 (-0.1, 0.8)0.1 1.0)0.1 (0.0, 0.7)0.9 †Interdialytic last session, kg4 (2.9%)2.3 3.2)2.5 (1.6, 3.3)1.8 (0.7, next kg6 (4.4%)2.3 (1.0, 3.1)2.5 (1.4, (0.5, 2.8)0.01 †Dialysis vintage, months3 (2.2%)27.8 (12.6, 56.8)28.9 (12.1, 52.7)27.2 (14.8, 61.9)0.8 †Ultrafiltration volume, L4 (2.9%)2.5 (1.7, 3.1)2.8 (1.9, 3.5)2.3 (1.5, 2.7)<0.01 duration, minutes43 (31%)228.5 (207.3, 234.0)229.0 (218.0, 234.0)212.0 (181.3, 234.0)0.03 †Systolic BP mmHg3 (2.2%)144.5 (131.3, 158.0)143.0 (131.0, 158.0)146.0 (135.3, 157.0)0.8 †Diastolic (2.2%)73.5 (65.0, 82.0)74.5 (67.0, 83.3)71.5 (62.3, 81.0)0.12 mmHg4 (2.9%)140.0 (123.0, 156.0)138.0 (120.0, 157.5)144.0 (126.5, 153.8)0.7 (2.9%)72.0 (63.0, 82.0)74.0 (64.0, 86.5)70.0 (62.0, 77.0)0.02 hypotension, %)7 (5.1%)13.0 (10.0%)7.0 (8.8%)6.0 (12.0%)0.8 ‡Venous hemoglobin g/dL3 (2.2%)11.4 (10.7, 12.2)11.7 (10.8, 12.3)11.2 (10.6, 12.0)0.09 †Previous albumin, g/dL2 (1.5%)3.4 (3.2, 3.7)3.4 3.7)0.7 total protein, (1.5%)6.9 (6.5, 7.2)7.0 (6.6, 7.2)6.9 (6.4, 7.2)0.2 †Bioimpedance characteristicsExtracellular resistance, Ohm0 (0%)530.2 (457.9, 590.6)518.5 (446.4, 564.1)554.4 (494.6, 620.6)0.01 †Intracellular (0%)1,596.7 (1,337.0, 1,959.3)1,501.7 (1,247.7, 1,838.5)1,844.2 (1,406.1, 2,174.0)<0.01 †Resistance infinite frequency, (0%)400.8 (342.3, 445.6)386.1 (327.4, 425.5)427.4 (371.0, 476.4)<0.01 †Capacitance, nF0 (0%)1.2 (0.9, 1.7)1.4 1.8)1.0 (0.8, 1.3)<0.01 †Time delay, ns0 (0%)0.2 (-1.3, 3.1)0.3 (-1.4, 3.1)0.2 3.3)0.7 †α, radian0 (0%)0.6 (0.6, 0.7)0.7 0.7)0.6 0.7)0.04 †Extracellular water, L0 (0%)18.5 (16.3, 21.3)19.8 (17.9, 22.7)16.3 (14.1, 18.3)<0.01 (0%)18.4 (15.6, 21.5)20.7 (17.7, 23.3)15.6 (13.6, 18.0)<0.01 †Total (0%)36.7 (31.8, 42.6)40.7 (36.2, 45.6)31.4 (28.1, 35.8)<0.01 †Volume (0%)2.4 3.5)2.7 4.0)1.9 3.0)0.03 pre-HD <2.5 (0%)69.0 (50.4%)37.0 (43.5%)32.0 (61.5%)0.06 ‡Relative %0 (0%)13.4 (7.9, 18.5)14.3 (8.2, 19.5)12.0 (6.0, 17.3)0.4 †Relative <15%0 (0%)80.0 (58.4%)47.0 (55.3%)33.0 (63.5%)0.4 ‡Lean (0%)12.4 (10.5, 14.6)13.4 (11.2, 15.6)11.0 (9.5, 13.0)<0.01 †Lean Δ reference, (0%)0.0 (-1.9, 1.7)-0.4 (-2.1, 1.7)0.4 (-0.8, 2.1)0.02 15-20 (0%)27.0 (19.7%)23.0 (27.1%)4.0 (7.7%)<0.01 ⋇Fat kg/m21 (0.7%)12.2 (9.6, 17.7)11.1 (9.1, 16.4)14.2 (9.9, 22.0)0.04 †Fat (0.7%)6.5 (3.6, 11.3)6.4 (3.7, 9.3)7.1 (3.0, 14.6)0.5 4-15 (0.7%)83.0 (61.0%)57.0 (67.9%)26.0 (50.0%)0.06 ‡Characteristics reported number (%) median (interquartile range). Albumin protein extracted form most recent routine laboratory before measurement. Abbreviations: BP, blood pressure; HD, hemodialysis.†Two-sample Wilcoxon test‡Chi-square test⋇Fisher's exact test Open table new tab Characteristics †Two-sample ‡Chi-square ⋇Fisher's summary, found significant VO, only terms, considered be "in-range" LTI. previously lower bioimpedance-derived sarcopenia (Item S3a). another study, subjectively-assessed muscle atrophy more often females, who exhibited poor nutritional S3b). our present terms. Other studies, prominently stressing these findings, indicate larger S3c-e) even S3f) males. While some authors suggested that threshold should sex-specific (7Zoccali Chazot Mallamaci F. Tripepi G. Arkossy O. al.Chronic Fluid Overload Mortality ESRD.J JASN. 2017 Aug; 28: 2491-2497Crossref evidence supporting this claim is so far lacking. Reasons may part originate physiological (less therefore less VO) varying patient preferences. expected, true remains unclear. spectroscopy, modeled input variables extra- intracellular height (8Moissl U.M. P.W. Bosaeus Levin Bosy-Westphal A. determination via health disease.Physiol 2006 27: 921-933Crossref (500) Scholar,9Chamney Müller M.J. Korth al.A whole-body model distinguish excess hydration major tissues.Am Clin Nutr. 85: 80-89Abstract (390) equations used Monitor, sex-dependent resistivities, shape factor density combined into one empirically-derived expression linear dependence Reference populations derive under- overrepresentation Scholar) based narrower ranges than typical (25.2 ± 3.7kg/m2 (9Chamney 26 5.3kg/m2 Scholar)), which could lead outside validation range. largely different sexes, independent index. limited its relatively small sample size retrospective, cross-sectional design. conclusion, identified notable among single center. For observed commented discussed previous datasets. Considering equal (although strata slightly than) (10ERA Registry: ERA Registry Annual Report 2021. Amsterdam UMC, location AMC, Department Informatics, Amsterdam, Netherlands, 2023.Google if values themselves sex-dependent. recommend reanalyzing existing large-scale datasets measures composition. Conceptualization: SM, PW, MH; Methodology: SM; Software: Formal Analysis: Investigation: JN, CM, SW; Resources: Data curation: Visualization: Supervision: Project administration: Funding acquisition: MH. Each author contributed important intellectual content during manuscript drafting revision accepts accountability work ensuring questions pertaining accuracy integrity any portion appropriately investigated resolved. supported Science Technology (WWTF) Precision Medicine Grant LS20-079. CC PW employees Fresenius Care, produces Monitor. DS coinventor patents field applications member American Renal Associates research board. MH served speaker and/or consultant Astellas Pharma, AstraZeneca, Eli Lilly, Janssen-Cilag, Siemens Healthcare, Vifor received academic support Boehringer Ingelheim, Nikkiso, Healthcare (not related work). remaining nothing declare. will made upon reasonable request corresponding author. Received March 2, 2024. Evaluated external peer reviewer, direct editorial Statistical Editor Editor-in-Chief. Accepted revised April 30, wish thank medical staff Ole Schecker Moritz Reuth additional acquisition. Download .pdf (1.49 MB) Help pdf files