«Dry weight» correction in hemodialysis patients based on the results of bioimpedance vector analysis

AIM OF RESEARCH. The aim of this study was to evaluate the capabilities of the bioimpedance vector analysis to assess aggregate hydration and nutritional status in hemodialysis patients and correction of «dry weight». PATIENTS AND METHODS. The study included 66 hemodialysis patients ($ = 42, $ = 24). The analysis of the blood pressure dynamics at each hemodialysis session as well as recording complications during the procedure were carried out during one month prior to the determination of the bioimpedance and «dry weight» correction and one month after the correction,: hypotension, seizures, hypertension episodes. In addition, the quality of life assessment using SF-36 questionnaire as well as nutritional status were performed prior to the determination of the bioimpedance. Bioimpedance was performed by multifrequency phase-sensitive bioimpedance analyzer NutriGuard-M (Data Input GmbH). Measurement of resistance (R) and reactance (Xc) were carried out at 5, 50 and 100 KHz. Bioimpedance vector analysis was performed at 50 KHz based on R and Xc axes, each of which were adjusted to the patient’s height. Simultaneously with assessment of the fluid status by bioimpedance vector the phase angle was also estimated. Achievement of the «dry weight» recommended after measuring of the bioimpedance was carried out gradually, depending upon the adaptive characteristics of each patient. RESULTS. The correction of «dry weight» was performed according to the results of the comprehensive evaluation of the patient hydration status: in 26 patients recommended weight was reduced by an average of 1,30±1,26 kg, in 20 patients the weight was increased by 0,60±0,29 kg, while in 20 patients the recommended weight was not changed. The frequency of hypertensive episodes after «dry weight» correction decreased by 0.44 episodes per month (95% CI: -0,84 ^ -0,08; p = 0.018) in whole group. Among patients with episodes of hypertension (44%) its frequency declined by 1.16 episode per month (95% CI: -1,87 ^ -0,45; p = 0.002). Among patients prone to hypotensive episodes its frequency decreased by 0,94 episedes per month (95% CI: -1,74 ^ -0,1; р=0,024). Such bioimpedance parameters as the phase angle, the cell mass proportion, the ratio of extracellular mass to body cell mass were significantly different in patients with serum albumin levels below and above 37 g/l (median). In addition to clinical and laboratory values the bioimpedance parameters were associated with the quality of life scales, mostly - with physical scales. CONCLUSION. The «dry weight» correction according to the results of bioimpedance vector analysis can improve blood pressure control and reduce the incidence of intradialytic complications. The phase angle, the cell mass proportion and the ratio of extracellular mass to body cell mass are directly linked with quality of life in the physical scales, as well as with nutritional status indicators.

«сухой вес», hemodialysis, bioimpedance, «dry weight», quality of life, nutritional status

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