Yashiro Masatomo, Ochiai Miyuki, Fujisawa Nao, Kadoya Yuko, Kamata Tadashi
Division of Medical Engineering, Faculty of Medical Care Sciences, Himeji Dokkyo University, Hyogo, Japan 670-8524.
Int J Artif Organs. 2013 Jan;36(1):7-16. doi: 10.5301/ijao.5000167.
Bioimpedance spectroscopy (BIS) is widely used to assess fluid status in hemodialysis (HD) patients. Our purpose is to evaluate filtration coefficients (Lpst) as an alternative test to assess fluid status by utilizing BIS as a reference test.
106 HD patients (determined group) were divided into two groups with (EX group: 53) or without excess fluid mass (ExF). ExF calculated from extracellular water and intracellular water measured by BIS. Multiple linear regression equation of Lpst was made using ExF (ExF/DW) and ultrafiltration rate (UFR/DW) to adjust Lpst (AdjLpst). The cut-off values of the tests for detection of EX were determined by receiver-operator characteristic curve analysis. Lpst, AdjLpst, serum atrial natriuretic peptide concentration (ANP), ultrasonically measured inferior vena cava diameter (IVCe/BSA), and blood volume change (Δ BV/TUF/DW) were examined. The detection abilities of these tests were evaluated in the distinct 61 patients (evaluated group).
Patients of the EX group numbered 29 in the evaluated group. The correlation between AdjLpst and ExF/DW was the highest. The sensitivity of AdjLpst and specificity of Lpst were the highest. The specificity of AdjLpst was equivalent to that of Lpst. Unadjusted and adjusted odds ratios of AdjLpst were the higher (20.80, 95% CI, 5.61-77.10, 16.06, 95% CI 4.00-64.59, respectively) than those of the other tests.
AdjLpst can detect patients of the EX group more accurately than other tests. Because AdjLpst is related to plasma refilling, it may indicate removable fluid overload. AdjLpst in conjunction with BIS may contribute to more adequate fluid management.
生物电阻抗光谱法(BIS)被广泛用于评估血液透析(HD)患者的液体状态。我们的目的是通过将BIS作为参考测试,评估滤过系数(Lpst)作为一种替代测试来评估液体状态。
106例HD患者(确定组)被分为有(EX组:53例)或无液体过多(ExF)两组。ExF由通过BIS测量的细胞外水和细胞内水计算得出。使用ExF(ExF/DW)和超滤率(UFR/DW)建立Lpst的多元线性回归方程以调整Lpst(调整后Lpst)。通过受试者工作特征曲线分析确定检测EX的测试的临界值。检测Lpst、调整后Lpst、血清心钠素浓度(ANP)、超声测量的下腔静脉直径(IVCe/BSA)和血容量变化(Δ BV/TUF/DW)。在另外61例患者(评估组)中评估这些测试的检测能力。
评估组中EX组患者有29例。调整后Lpst与ExF/DW之间的相关性最高。调整后Lpst的敏感性和Lpst的特异性最高。调整后Lpst的特异性与Lpst相当。调整后Lpst的未调整和调整后的优势比分别高于其他测试(分别为20.80,95%CI,5.61 - 77.10;16.06,95%CI 4.00 - 64.59)。
调整后Lpst比其他测试能更准确地检测出EX组患者。由于调整后Lpst与血浆再充盈有关,它可能表明可去除的液体过载。调整后Lpst与BIS结合可能有助于更充分的液体管理。