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. 2018 Sep;33(9):1601-1607.
doi: 10.1007/s00467-018-3971-x. Epub 2018 Jun 4.

Validating the use of bioimpedance spectroscopy for assessment of fluid status in children

Indranil Dasgupta  1 , David Keane  2 , Elizabeth Lindley  2 , Ihab Shaheen  3 , Kay Tyerman  3 , Franz Schaefer  4 , Elke Wühl  4 , Manfred J Müller  5 , Anja Bosy-Westphal  6 , Hans Fors  7 , Jovanna Dahlgren  7 , Paul Chamney  8 , Peter Wabel  8 , Ulrich Moissl  8
Affiliations

Validating the use of bioimpedance spectroscopy for assessment of fluid status in children

Indranil Dasgupta et al. Pediatr Nephrol. 2018 Sep.

Abstract

Background: Bioimpedance spectroscopy (BIS) with a whole-body model to distinguish excess fluid from major body tissue hydration can provide objective assessment of fluid status. BIS is integrated into the Body Composition Monitor (BCM) and is validated in adults, but not children. This study aimed to (1) assess agreement between BCM-measured total body water (TBW) and a gold standard technique in healthy children, (2) compare TBW_BCM with TBW from Urea Kinetic Modelling (UKM) in haemodialysis children and (3) investigate systematic deviation from zero in measured excess fluid in healthy children across paediatric age range.

Methods: TBW_BCM and excess fluid was determined from standard wrist-to-ankle BCM measurement. TBW_D2O was determined from deuterium concentration decline in serial urine samples over 5 days in healthy children. UKM was used to measure body water in children receiving haemodialysis. Agreement between methods was analysed using paired t test and Bland-Altman method comparison.

Results: In 61 healthy children (6-14 years, 32 male), mean TBW_BCM and TBW_D2O were 21.1 ± 5.6 and 20.5 ± 5.8 L respectively. There was good agreement between TBW_BCM and TBW_D2O (R2 = 0.97). In six haemodialysis children (4-13 years, 4 male), 45 concomitant measurements over 8 months showed good TBW_BCM and TBW_UKM agreement (mean difference - 0.4 L, 2SD = ± 3.0 L). In 634 healthy children (2-17 years, 300 male), BCM-measured overhydration was - 0.1 ± 0.7 L (10-90th percentile - 0.8 to + 0.6 L). There was no correlation between age and OH (p = 0.28).

Conclusions: These results suggest BCM can be used in children as young as 2 years to measure normally hydrated weight and assess fluid status.

Keywords: Bioimpedance; Children; Chronic kidney disease; Fluid volume; Haemodialysis; Overhydration; Total body water.

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Conflict of interest statement

EL received honoraria from Fresenius Medical Care for providing training in the use of bioimpedance spectroscopy in renal care.

PC, PW and UM are employees of Fresenius Medical Care.

Figures

Fig. 1
Fig. 1
TBW BCM vs. TBW D20 in 60 healthy children aged between 6 and 14 years. Corresponding Bland-Altman plot is shown in Supplementary Fig. S1. All subjects R2 = 0.97 (p < 0.001), Girls R2 = 0.97 (p < 0.001) and Boys: R2 = 0.98 (p < 0.001). BCM Body Composition Monitor, D2O deuterium oxide, TBW total body water
Fig. 2
Fig. 2
TBW_BCM vs. TBW_UKM in 6 children on haemodialysis. Measurements were made over 8 months. Corresponding Bland-Altman plot is shown in Supplementary Fig. S2. The same data but individually averaged is shown in Supplementary Figs. S3 and S4. Dashed line indicates line of identity. TBW total body water, BCM Body Composition Monitor, UKM Urea Kinetic Modelling
Fig. 3
Fig. 3
BCM-measured OH (a) and OH/ ECW (b) in all healthy children (n = 634). Boxes indicate interquartile range from 25th to 75th percentile, line is the median, notches indicate 95% confidence interval for median, whiskers are 1.5*interquartile range (covering 99.3% of data assuming normal distribution), crosses = outliers. BCM Body Composition Monitor, OH over hydration, ECW extra cellular water
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