Division of Nephrology, Children's Hospital of New Orleans, 200 Henry Clay Ave, New Orleans, LA, 70118, USA.
Data Science & Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA.
BMC Nephrol. 2023 Jan 5;24(1):5. doi: 10.1186/s12882-022-03012-1.
Fluid overload is associated with morbidity and mortality in children receiving dialysis. Accurate clinical assessment is difficult, and using deuterium oxide (DO) to measure total body water (TBW) is impractical. We investigated the use of ultrasound (US), bioimpedance spectroscopy (BIS), and anthropometry to assess fluid removal in children receiving maintenance hemodialysis (HD).
Participants completed US, BIS, and anthropometry immediately before and 1-2 h after HD for up to five sessions. US measured inferior vena cava (IVC) diameter, lung B-lines, muscle elastography, and dermal thickness. BIS measured the volume of extracellular (ECF) and intracellular (ICF) fluid. Anthropometry included mid-upper arm, calf and ankle circumferences, and triceps skinfold thickness. DO was performed once pre-HD. We assessed the change in study measures pre- versus post-HD, and the correlation of change in study measures with percent change in body weight (%∆BW). We also assessed the agreement between TBW measured by BIS and DO.
Eight participants aged 3.4-18.5 years were enrolled. Comparison of pre- and post-HD measures showed significant decrease in IVC diameters, lung B-lines, dermal thickness, BIS %ECF, mid-upper arm circumference, ankle, and calf circumference. Repeated measures correlation showed significant relationships between %∆BW and changes in BIS ECF (r =0.51, 95% CI 0.04, 0.80) and calf circumference (r=0.80, 95% CI 0.51, 0.92). BIS TBW correlated with DO TBW but overestimated TBW by 2.2 L (95% LOA, -4.75 to 0.42).
BIS and calf circumference may be helpful to assess changes in fluid status in children receiving maintenance HD. IVC diameter, lung B-lines and dermal thickness are potential candidates for future studies.
液体超负荷与接受透析治疗的儿童的发病率和死亡率有关。准确的临床评估很困难，而使用重水（DO）测量总体水量（TBW）是不切实际的。我们研究了超声（US）、生物阻抗谱（BIS）和人体测量学在接受维持性血液透析（HD）的儿童中评估液体清除的应用。
参与者在接受 HD 治疗前和治疗后 1-2 小时内进行了多达 5 次 US、BIS 和人体测量学检查。US 测量下腔静脉（IVC）直径、肺 B 线、肌肉弹性成像和皮肤厚度。BIS 测量细胞外液（ECF）和细胞内液（ICF）的体积。人体测量学包括上臂中部、小腿和脚踝周长以及三头肌皮褶厚度。DO 在 HD 前进行一次。我们评估了研究指标在治疗前后的变化，以及研究指标的变化与体重百分比变化（%∆BW）的相关性。我们还评估了 BIS 和 DO 测量的 TBW 之间的一致性。
共纳入 8 名年龄 3.4-18.5 岁的参与者。与 HD 前后的测量值相比，IVC 直径、肺 B 线、皮肤厚度、BIS %ECF、上臂中部周长、脚踝和小腿周长均显著降低。重复测量相关性显示，%∆BW 与 BIS ECF 的变化（r=0.51，95%CI 0.04，0.80）和小腿周长的变化（r=0.80，95%CI 0.51，0.92）显著相关。BIS TBW 与 DO TBW 相关，但高估了 2.2L（95% LOA，-4.75 至 0.42）。
BIS 和小腿周长可能有助于评估接受维持性 HD 的儿童的液体状态变化。IVC 直径、肺 B 线和皮肤厚度是未来研究的潜在候选指标。
