Combined evaluation of nutrition and hydration in dialysis patients with bioelectrical impedance vector analysis (BIVA)
Abstract
Background & aims Body hydration changes continuously in hemodialysis patients. The Subjective Global Assessment (SGA) is used for the nutritional evaluation but it does not allow a direct evaluation of hydration. Bioelectrical impedance vector analysis (BIVA) is very sensitive to hydration. The potential of the combined evaluation of hydration and nutrition with SGA and BIVA is still lacking.Methods Observational cross-sectional study on 130 (94 Male) uremic patients undergoing chronic hemodialysis three times a week. Nutritional status was evaluated with the SGA. Each subject was classified as SGA-A (normal nutritional status), SGA-B (moderate malnutrition), or SGA-C (severe malnutrition). Body hydration was evaluated with BIVA. The two vector components resistance (R) and reactance (Xc) were normalized by the subject's height and standardized as bivariate Z-score, i.e. Z(R) and Z(Xc).Results Undernutrition influenced impedance vector distribution both before and after a dialysis session. In pre-dialysis, the mean vector of SGA A was inside the 50% tolerance ellipse. In SGA B and C, Z(R) was increased and Z(Xc) decreased, indicating a progressive loss of soft tissue mass. Fluid removal with dialysis increased both Z(R) and Z(Xc) in SGA A and B but not in C. With ROC curve analysis on the slope of increase, we found the cutoff value of 27.8° below which undernutrition was present, either moderate or severe. The area under the ROC curve was 77.7° (95% CI 69.5-84.5, P < .0001) with sensitivity 75.9%, specificity 78.6%, positive predicted value 74.6%, and negative predicted value 79%.Conclusions The distribution of impedance vectors is associated with the SGA classification of patients. The change in body hydration in each SGA category can be detected with BIVA.
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Fluctuations in water content may manifest more frequently in people with diseases compared to other populations.
“This is imperative due to the heightened likelihood of fluctuations in water content, which may manifest more frequently in this cohort compared to other populations [105].”
From High-standard predictive equations for estimating body composition using bioelectrical impedance analysis: a systematic review (2024) · cites this paper as [105]
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Campa, F., Coratella, G., Cerullo, G., Noriega, Z., Francisco, R., Charrier, D., Irurtia, A., Lukaski, H., Silva, A. M., & Paoli, A. (2024) · Journal of Translational Medicine · doi:10.1186/s12967-024-05272-x · Cited by 80 · see citing works
“This is imperative due to the heightened likelihood of fluctuations in water content, which may manifest more frequently in this cohort compared to other populations [105].”
Background
- Authors
- Piccoli, A., Codognotto, M., Piasentin, P., & Naso, A.
- Affiliations
- University of Padua (IT)
- Corresponding author
- Piccoli, Antonio
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 33
- Issue
- 4
- Pages
- 673-677
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2023847552
- Cited by
- 67
- References
- 17
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 9 · 2023: 6 · 2022: 7 · 2021: 7 · 2020: 6 · 2019: 8 · 2018: 2 · 2017: 4 · 2016: 2 · 2015: 7 · 2014: 2
- FWCI
- 2.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- bioelectrical impedance vector analysis, hemodialysis, nutritional status, body hydration, malnutrition, Subjective Global Assessment, uremic patients, fluid removal, soft tissue mass
- MeSH terms
- Aged, Aged, 80 and over, Body Water, Cross-Sectional Studies, Female, Renal Dialysis, Humans, Male, Middle Aged, Nutritional Status, Nutrition Assessment, Electric Impedance, Malnutrition
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