Panorchan Kwanpeemai, Nongnuch Arkom, El-Kateb Sally, Goodlad Cate, Davenport Andrew
Department of Nephrology, Bumrungrad International Hospital, Bangkok, Thailand.
Renal Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Hemodial Int. 2015 Oct;19(4):484-9. doi: 10.1111/hdi.12282. Epub 2015 Mar 6.
Multifrequency bioelectrical impedance assessments (MFBIAs) aid clinical assessment of hydration status for hemodialysis (HD) patients. Many MFBIA devices are restricted to whole body measurements and as many patients dialyze using arteriovenous fistulas (AVFs), we wished to determine whether AVFs affected body water measurements. We reviewed pre- and post-HD segmental MFBIA measurements in 229 patients attending for midweek HD sessions. Up to 144 were dialyzed with a left arm AVF (L-AVF), 42 with a right arm AVF (R-AVF), and 43 by central venous access catheter (CVC). Water content and lean tissue were greater in the left compared to right arm in those patients with L-AVFs both pre and post dialysis (pre 2.1 ± 0.7 vs. 2.0 ± 0.7 L, and post 1.9 ± 0.6 vs. 1.8 ± 0.6 L and pre 2.65 ± 0.9 vs. 2.56 ± 0.8 kg, and post 2.34 ± 0.8 vs. 2.48 ± 0.8 vs. 2.34 ± 0.8 kg, respectively) and were also greater in the right compared to left arm for those patients dialyzing with R-AVFs (pre-HD 1.92 ± 0.5 vs. 1.86 ± 0.6 L and post-HD 1.79 ± 0.5 vs. 1.7 ± 0.5 L, and pre-HD 2.47 ± 0.6 vs. 2.38 ± 0.7 kg and post-HD 2.3 ± 0.74 vs. 1.28 ± 0.7 kg, respectively), all Ps < 0.05. There were no significant differences in arm volumes or composition pre or post dialysis in those dialyzing with CVCs. Segmental MFBIA detects differences in arm water and lean mass in patients with AVFs. The presence on an AVF increases the water content in the ipsilateral arm both pre and post HD. This increased water content of the fistula arm will not be detected by whole body bioimpedance devices.
多频生物电阻抗评估（MFBIAs）有助于对血液透析（HD）患者的水合状态进行临床评估。许多MFBIAs设备仅限于全身测量，而且由于许多患者使用动静脉内瘘（AVF）进行透析，我们希望确定AVF是否会影响身体水分测量。我们回顾了229名参加周中HD治疗的患者在HD治疗前后的节段性MFBIAs测量结果。多达144名患者通过左上肢AVF（L-AVF）进行透析，42名通过右上肢AVF（R-AVF）进行透析，43名通过中心静脉置管（CVC）进行透析。在透析前和透析后，L-AVF患者的左上肢水含量和瘦组织均高于右上肢（透析前分别为2.1±0.7L对2.0±0.7L，透析后为1.9±0.6L对1.8±0.6L；透析前分别为2.65±0.9kg对2.56±0.8kg，透析后为2.34±0.8kg对2.48±0.8kg对2.34±0.8kg），R-AVF患者的右上肢水含量和瘦组织也高于左上肢（HD前1.92±0.5L对1.86±0.6L，HD后1.79±0.5L对1.7±0.5L；HD前2.47±0.6kg对2.38±0.7kg，HD后2.3±0.74kg对1.28±0.7kg），所有P值均<0.05。使用CVC进行透析的患者在透析前或透析后的手臂体积或成分没有显著差异。节段性MFBIAs可检测出AVF患者手臂水分和瘦体重的差异。AVF的存在会增加HD前后同侧手臂的水含量。全身生物电阻抗设备无法检测到内瘘手臂增加的水含量。
