Mohamed Maha, Matthie Jim, Fan Stanley L
Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK.
Matthie Consulting, La Jolla, CA, USA.
Semin Dial. 2025 Jan-Feb;38(1):71-81. doi: 10.1111/sdi.13084. Epub 2022 Apr 25.
Volume status can be difficult to assess in dialysis patients. Peripheral edema, elevated venous pressure, lung crackles, and hypertension are taught as signs of fluid overload, but sensitivity and specificity are poor. Bioimpedance technology has evolved from early single frequency to multifrequency machines which apply spectroscopic analysis (BIS), modeling data to physics-based mixture theory. Bioimpedance plots can aid the evaluation of hydration status and body composition. The challenge remains how to use this information to manage dialysis populations, particularly as interventions to improve over hydration, sarcopenia, and adiposity are not without side effects. It is therefore of no surprise that validation studies for BIS use in peritoneal dialysis patients are limited, and results from clinical trials are inconsistent and conflicting. Despite these limitations, BIS has clinical utility with potential to accurately evaluate small changes in body tissue components. This article explains the information a BIS plot ("picture") can provide and how it can contribute to the overall clinical assessment of a patient. However, it remains the role of the clinician to integrate information and devise treatment strategies to optimize competing patient risks, fluid and nutrition status, effects of high glucose PD fluids on membrane function, and quality of life issues.
在透析患者中，容量状态可能难以评估。外周水肿、静脉压升高、肺部啰音和高血压被视为液体过载的体征，但敏感性和特异性较差。生物阻抗技术已从早期的单频机器发展到应用光谱分析（生物电阻抗光谱法，BIS）的多频机器，根据基于物理的混合理论对数据进行建模。生物阻抗图有助于评估水合状态和身体组成。挑战仍然在于如何利用这些信息来管理透析人群，特别是因为改善水合过度、肌肉减少症和肥胖的干预措施并非没有副作用。因此，毫不奇怪，腹膜透析患者使用BIS的验证研究有限，临床试验结果也不一致且相互矛盾。尽管有这些局限性，BIS仍具有临床实用性，有潜力准确评估身体组织成分的微小变化。本文解释了BIS图（“图像”）可以提供的信息以及它如何有助于对患者进行全面的临床评估。然而，整合信息并制定治疗策略以优化患者相互冲突的风险、液体和营养状态、高糖腹膜透析液对膜功能的影响以及生活质量问题，仍然是临床医生的职责。
