Bioimpedance Measurement in the Kidney Disease Patient
نویسندگان
چکیده
1.1 The problematic of hydration status in the kidney disease patient Dry weight corresponds to the body weight of a person with normal extracellular fluid volume [1]. In the context of hemodialysis, dry weight is the weight reached at the end of the dialysis session by patients who will remain free of orthostatic hypotension or hypertension until the next session. Clinicians are thus obliged to estimate the appropriate dry weight each individual patient should reach at the end of a dialysis session. If this weight is underestimated, the patients are at risk of various incidents ranging from simple yawning to death. Low dry weight also carries a permanent risk of hypotension, cramps, nausea, vomiting or ischemia. If this weight is overestimated, chronic hyperhydration can cause acute events including pulmonary edema, or hypertension, but also long-term consequences affecting cardiovascular morbidity and mortality [2]. This important notion of dry weight is however quite problematic because it corresponds to a transient state, making it necessary to anticipate weight gain between two dialysis sessions and thus to reach a certain degree of dehydration at the end of each hemodialysis session. The many methods proposed for measuring dry weight and body composition are still under investigation. The difficulty encountered in establishing a reliable comparative tool for measuring these parameters arises from inevitable physiological, anatomical and physical variability. Most approaches remain empirical, relying on feedback from trial and error [3]. In practice, dry weight is estimated clinically [4]. Physical examination is a classic but limited tool. Solid evidence-based analysis of specific physical findings such as systolic blood pressure, orthostatic blood pressure, or the presence or not of edema is lacking. Such clinical symptoms can also be related to conditions other than a dry weight or body composition problem. Several tests have been proposed to assess the dry weight of hemodialysis patients [5]. Echocardiographic inferior vena cava diameter and biochemical markers are available but results exhibit high variability and poor correlation with extracellular volume; there are also unserviceable in detecting volume depletion. Bioimpedance spectroscopy measurement has been demonstrated as a potentially useful method to determine the physiological status of living tissues [6]. Disease-related alterations are associated with variations in essential tissue parameters such as physical structure or ionic composition that can be detected as changes in passive electrical properties.
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