Hemodialysis: Bioimpedance predicts access failure
Segmental bioimpedance analysis (BIA) can identify fluid volume changes in the arms of hemodialysis (HD) patients after vascular access surgery, explain South Korean researchers from Jeju National University Hospital.
In their present study, the authors aimed to find out whether differences in fluid volumes in the arms of HD patients, as measured by segmental BIA, would be associated with vascular access outcomes (Kim H et al, Prediction of hemodialysis vascular access failure using segmental bioimpedance analysis parameters; Int Urol Nephrol. 2018; doi: 10.1007/s11255-018-1827-8).
The authors used segmental, multi-frequency BIA equipment to measure the body composition of 127 HD patients and calculated the difference in fluid volumes between the arms of the patients (i.e. the fluid volume of the arm with the vascular access minus fluid volume of the arm without the vascular access). Primary outcome was the loss of vascular access patency within three months of BIA measurement.
The median absolute and relative inter-arm fluid volume differences were 150 ml and 9.6%, respectively. 30 percent of patients experienced vascular access failure within three months of the measurement. After the authors had divided the patients into three groups based on the tertiles of relative inter-arm fluid volume differences (lowest tertile: < 6.8%; middle tertile: 6.8–12.7%; highest tertile: > 12.7%), they found that a greater difference in relative inter-arm fluid volume differences was associated with higher vascular access failure rates (14 vs. 28 vs. 48%, p = 0.003).
The authors conclude that segmental BIA could be used as tool to predict vascular access failure in patients on HD by calculating the relative difference in fluid volume between the patient’s arm with vascular access and the arm without.
Link to the study: https://link.springer.com/article/10.1007%2Fs11255-018-1827-8