Bioimpedance for assessing volume status in children with nephrotic syndrome
Background/aim: The effectiveness of assessing volume load via bioimpedance in pediatric patients with nephrotic syndrome (NS) was investigated. Materials and methods: Patients with NS (n = 34) were compared with healthy controls (n = 20). The inferior vena cava index and inferior vena cava collapsibility index (IVCCI) scores were determined for all subjects. Bioimpedance measurements were used to directly determine volume load. Clinical findings, relative fluid load, and echocardiographic measurements were determined and compared with bioimpedance in calculating volume load. Results: The sensitivity and specificity of bioimpedance in determining volume load were found to be 65% and 90%, respectively. IVCCI was lower in NS patients than in controls. There were also significant differences in IVCCI values between patients with localized and generalized edema. Relative fluid load was higher in NS patients with generalized edema as opposed to patients with localized edema. For calculating volume load, the sensitivity of bioimpedance, clinical findings, and echocardiographic measurements was 87%, 95%, and 83%, respectively, whereas the specificity of determining volume load by bioimpedance, clinical findings, and echocardiographic measurements was 50%, 10%, and 80%, respectively. Conclusion: Our data suggest that bioimpedance may be superior to echocardiography in determining volume load in children with NS, because it is cost-effective, reliable, and relatively simple to perform.
Bioimpedance for assessing volume status in children with nephrotic syndrome
Background/aim: The effectiveness of assessing volume load via bioimpedance in pediatric patients with nephrotic syndrome (NS) was investigated. Materials and methods: Patients with NS (n = 34) were compared with healthy controls (n = 20). The inferior vena cava index and inferior vena cava collapsibility index (IVCCI) scores were determined for all subjects. Bioimpedance measurements were used to directly determine volume load. Clinical findings, relative fluid load, and echocardiographic measurements were determined and compared with bioimpedance in calculating volume load. Results: The sensitivity and specificity of bioimpedance in determining volume load were found to be 65% and 90%, respectively. IVCCI was lower in NS patients than in controls. There were also significant differences in IVCCI values between patients with localized and generalized edema. Relative fluid load was higher in NS patients with generalized edema as opposed to patients with localized edema. For calculating volume load, the sensitivity of bioimpedance, clinical findings, and echocardiographic measurements was 87%, 95%, and 83%, respectively, whereas the specificity of determining volume load by bioimpedance, clinical findings, and echocardiographic measurements was 50%, 10%, and 80%, respectively. Conclusion: Our data suggest that bioimpedance may be superior to echocardiography in determining volume load in children with NS, because it is cost-effective, reliable, and relatively simple to perform.
___
- Glassock RJ, Cohen AH, Adler SG. Primary glomerular disease. In: Brenner BM, editor. The Kidney. 5th ed. Philadelphia, PA, USA: WB Saunders; 1996. pp. 1392–1497.
- Vande Walle JG, Donckerwolcke RA, Van Isselt JW, Derkx FHM, Joles JA, Koomans HA. Volume regulation in children with early relapse of minimal change nephrosis with or without hypovolemic symptoms. Lancet 1995; 346: 148–152.
- Geers AB, Koomans HA, Boer EJ, Mees Dorhout EJ. Plasma and blood volumes in patients with nephrotic syndrome. Nephron 1984; 38: 170–173.
- Koomans HA, Geers AB, Mees Dorhout EJ, Kortlandt W. Lowered tissue fluid oncotic pressure protects the blood volume in the nephrotic syndrome. Nephron 1986; 42: 317– 322.
- Schnaper HW, Robson AM. Nephrotic syndrome. In: Schrier RW, editor. Disease of the Kidney and Urinary Tract. 7th ed. Philadelphia, PA, USA: Lippincott Williams & Wilkins; 2001. pp. 1773–1832.
- Vande Walle J, Donckerwolcke R, Boer P, Van Isselt HW, Koomans HA, Joles JA. Blood volume, colloid osmotic pressure and F-cell ratio in children with the nephrotic syndrome. Kidney Int 1996; 49: 1471–1477. 7. Andreoli TE. Edematous states: an overview. Kidney Int 1997; 51: 21–27.
- Ruffmann K, Mandelbaum A, Bommer J, Schmidli M, Ritz E . Doppler echocardiographic findings in dialysis patients. Nephrol Dial Transplant 1990; 5: 426–431.
- Weyman A. Right ventricular inflow tract. In: Weyman A, editor. Principles and Practice of Echocardiography. 2nd ed. Philadelphia, PA, USA: Lea and Febiger; 1994. pp. 853–854.
- Krause I, Birk E, Davidovits M, Cleper R, Blieden L, Pinhas L. Inferior vena cava diameter: a useful method for estimation of fluid status in children on haemodialysis. Nephrol Dial Transplant 2001; 16: 1203–1206.
- Cheriex EC, Leunissen KM, Janssen JH, Mooy JM, van Hooff JP. Echography of the inferior vena cava is a simple and reliable tool for estimation of “dry weight” in haemodialysis patients. Nephrol Dial Transplant 1989; 4: 563–568.
- Mandelbaum A, Ritz E. Vena cava diameter measurement for estimation of dry weight in haemodialysis patients. Nephrol Dial Transplant 1996; 11: 24–27.
- Buchholdz AC, Bartok C, Schoeller DA. The validity of bioelectrical impedance models in clinical populations. Nutr Clin Pract 2004; 19: 433–446.
- Lee SW, Song JH, Kim GA, Lee KJ, Kim MJ. Assessment of total body water from anthropometry-based equations using bioelectrical impedance as reference in Korean adult control and haemodialysis subjects. Nephrol Dial Transplant 2001; 16: 91–97.
- Park MK. Chest roentgenography. In: Park MK, editor. Pediatric Cardiology for Practitioners. 3rd ed. St Louis, MO, USA: Mosby; 1996. pp. 52–59.
- Wabel P, Moissl U, Chamney P, Jirka T, Machek P, Ponce P, Taborsky P, Tetta C, Velasco N, Vlasak J et al. Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload. Nephrol Dial Transplant 2008; 9: 2965–2971.
- Vande Walle JGJ, Donckerwolcke RA. Pathogenesis of edema formation in the nephrotic syndrome. Pediatr Nephrol 2001; 16: 283–293.
- Hamm LL, Batuman V. Edema in the nephrotic syndrome: new aspect of an old enigma. J Am Soc Nephrol 2003; 14: 3288– 3289.
- Deschenes G, Feraille E, Doucet A. Mechanisms of edema in nephrotic syndrome: old theories and new ideas. Nephrol Dial Transplant 2003; 18: 454–456.
- Ishibe S, Peixoto A. Methods of assessment of volume status and intercompartmental fluid shifts in hemodialysis patients: implications in clinical practice. Semin Dial 2004; 17: 37–43.
- Sonmez F, Mir S, Ozyurek R, Cura A. The adjustment of post- dialysis dry weight based on non-invasive measurements in children. Nephrol Dial Transplant 1996; 211: 1564–1567.
- Dönmez O, Mir S, Özyürek R, Cura A, Kabasakal C. Inferior vena cava indices determine volume load in minimal lesion nephrotic syndrome. Pediatr Nephrol 2001; 16: 251–255.
- Jaeger JQ, Mehta RL. Assessment of dry weight in hemodialysis: an overview. J Am Soc Nephrol 1999; 10: 392–403.
- Ghaffari S, Malaki M, Ghaffari MR, Asiaie K. Inferior vena cava index in edematous patients. J Cardiovasc Thorac Res 2012; 4: 69–71.
- Fagugli RM, Pasini P, Quintaliani G, Pasticci F, Ciao G, Cicconi B, Ricciardi D, Santirosi PV, Buoncristiani E, Timio F et al. Short daily hemodialysis: blood pressure control and left ventricular mass reduction in hypertensive haemodialysis patients. Am J Kidney Dis 2001; 38: 371–376.
- Spiegel DM, Bashir K, Fisch B. Bioimpedance resistance ratios for the evaluation of dry weight in hemodialysis. Clin Nephrol 2000; 53: 108–114.
- Wizemann V, Wabel P, Chamney P, Zaluska W, Moissl U, Rode C, Malecka-Masalska T, Marcelli D. The mortality risk of overhydration in haemodialysis patients. Nephrol Dial Transplant 2009; 24: 1574–1579.
- Gurgoze MK, Gunduz Z, Poyrazoglu MH, Dursun I, Uzum K, Dusunsel R. Role of sodium during formation of edema in children with nephrotic syndrome. Pediatr Int 2011; 53: 50–56.