ESPN 50th Annual Meeting

ESPN 2017


 
Agreement of fluid assessment measured using pre-dialysis bioimpedance spectroscopy versus clinical judgement in children on chronic haemodialysis
ZAINAB ARSLAN 1 ARRAN WHEATLEY 1 CARMEN BARTON 1 CHRIS REID 1 MANISH SINHA 1

1- EVELINA LONDON CHILDRENS HOSPITAL
 
Introduction:

Body composition monitoring using a multifrequency bioimpedance (BCM-BIS) device has been shown to be a useful tool in the assessment of dry weight in adult haemodialysis (HD) patients. There is limited data regarding its clinical utility in children. 

Aim: Our aim was to investigate the agreement of fluid assessment measured pre-dialysis using BCM-BIS with clinical judgement in children on chronic haemodialysis. 

Material and methods:

Estimated dry weight (EDW) was calculated in all patients using a combination of clinical examination and observations during dialysis and history of symptoms and signs during and/or post dialysis of muscle cramps, dizziness, hypotension or hypertension. As per clinical judgement, the fluid volume to be removed at each dialysis session was calculated as the difference between pre-dialysis weight and EDW (FAclinical). We analysed agreement of fluid assessment using BCM-BIS (FAbcm) with FAclinical when the two were <0.5l; 0.5-1l; and >1l with one another. We further analysed fluid assessment as measured by FAbcm with FAclinical as a percent change (gain or loss) of EDW.

Results:

Single centre, retrospective review including 8 children with 58 BCM-BIS measurements. We excluded children younger than 5 years. Mean age was 10.2yrs (range 5-17yrs) including 5 boys. Fluid assessment following pre-dialysis measurement by FAbcm was <0.5l in 31 (53%), between 0.5-1l in 11 (19%) and >1l in 16 (28%) when compared with FAclinical; with no significant correlation between FAbcm and FAclinical (p=0.12). Comparison of FAbcm with FAclinical as a percent change of EDW suggests that although the vast majority of FAbcm measurements were similar with FAclinical there was a significant difference in the absolute volumes suggested by FAbcm when compared with FAclinical (figure). 

Conclusions:

There is poor agreement between fluid assessment performed using bioimpedance and clinical evaluation with significant differences in the estimated fluid gain or loss by bioimpedance in children on chronic haemodialysis.