Tzamaloukas Antonios H, Onime Aideloje, Agaba Emmanuel I, Vanderjagt Dorothy J, Ma Irene, Lopez Andrea, Tzamaloukas Rolinda A, Glew Robert H
Department of Medicine Service, New Mexico Veterans Affairs Health Care System and University of New Mexico School of Medicine, Albuquerque, NM 87108, USA.
Hemodial Int. 2007 Oct;11 Suppl 3:S22-8. doi: 10.1111/j.1542-4758.2007.00225.x.
The state of hydration affects the outcomes of chronic dialysis. Bioelectrical impedance analysis (BIA) provides estimates of body water (V), extracellular volume (ECFV), and fat-free mass (FFM) that allow characterization of hydration. We compared single-frequency BIA measurements before and after 14 hemodialysis sessions in 10 Nigerian patients (6 men, 4 women; 44+/-7 years old) with clinical evaluation (weight removed during dialysis, presence of edema) and with estimates of body water obtained by the Watson, Chertow, and Chumlea anthropometric formulas. Predialysis and postdialysis values of body water did not differ between BIA and anthropometric estimates. However, only the BIA estimate of the change in body water during dialysis (-0.8+/-2.9 L) did not differ from the corresponding change in body weight (-1.3+/-3.0 kg), while anthropometric estimates of the change in body water were significantly lower, approximately one-third of the change in weight. Bioelectrical impedance analysis correctly detected the intradialytic change in body water content (the ratio V/Weight) in 79% of the cases, while anthropometric formula estimates of the same change were erroneous in each case. Compared with patients with clinical postdialysis euvolemia (n=7), those with postdialysis edema (n=5) had higher values of postdialysis BIA ratios V/FFM (0.77+/-0.01 vs. 0.72+/-0.03, p<0.01) and ECFV/V (0.53+/-0.02 vs. 0.47+/-0.06, p<0.05), respectively. Bioelectrical impedance analysis appeared to underestimate body water and extracellular volume in a patient with massive ascites and bilateral pleural effusions. Anthropometric formulas are not appropriate for evaluating the state of hydration in patients on chronic hemodialysis. In contrast, BIA provides estimates of hydration agreeing with clinical estimates in the same patients, although it tends to underestimate body water and extracellular volume in patients with large collections of fluid in central body cavities.
水合状态会影响慢性透析的结果。生物电阻抗分析（BIA）可提供机体水分（V）、细胞外液量（ECFV）和去脂体重（FFM）的估计值，从而对水合状态进行特征描述。我们对10名尼日利亚患者（6名男性，4名女性；44±7岁）在14次血液透析前后进行了单频BIA测量，并与临床评估（透析过程中去除的体重、水肿情况）以及通过沃森、切尔托夫和丘姆利亚人体测量公式获得的机体水分估计值进行了比较。BIA和人体测量估计值之间的透析前和透析后机体水分值没有差异。然而，只有BIA对透析期间机体水分变化的估计值（-0.8±2.9升）与相应的体重变化（-1.3±3.0千克）没有差异，而人体测量对机体水分变化的估计值则显著较低，约为体重变化的三分之一。生物电阻抗分析在79%的病例中正确检测到了透析期间机体水分含量的变化（V/体重比值），而人体测量公式对相同变化的估计在每种情况下都是错误的。与透析后临床血容量正常的患者（n = 7）相比，透析后有水肿的患者（n = 5）透析后BIA的V/FFM比值（0.77±0.01对0.72±0.03，p<0.01）和ECFV/V比值（0.53±0.02对0.47±0.06，p<0.05）更高。生物电阻抗分析似乎低估了一名有大量腹水和双侧胸腔积液患者的机体水分和细胞外液量。人体测量公式不适用于评估慢性血液透析患者的水合状态。相比之下，BIA提供的水合估计值与同一患者的临床估计值相符，尽管它往往会低估体腔中积液较多患者的机体水分和细胞外液量。
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