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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2015  |  Volume : 26  |  Issue : 6  |  Page : 1311-1313
Non-invasive screening tool for chronic kidney disease


1 Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
2 Department of Nephrology, Madras Medical Mission, Chennai, India
3 Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

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Date of Web Publication30-Oct-2015
 

How to cite this article:
Saxena A, Gupta A, Abraham G, Sakhuja V, Jha V. Non-invasive screening tool for chronic kidney disease. Saudi J Kidney Dis Transpl 2015;26:1311-3

How to cite this URL:
Saxena A, Gupta A, Abraham G, Sakhuja V, Jha V. Non-invasive screening tool for chronic kidney disease. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2021 Dec 3];26:1311-3. Available from: https://www.sjkdt.org/text.asp?2015/26/6/1311/168697
To the Editor,

In healthy individuals, total body water (TBW) is constantly maintained, but it is affected and altered by disease, especially endstage renal disease. [1],[2] Several techniques that are used to evaluate body compartments include isotope dilution, hydrodensitometry, dualenergy X-ray absorptiometry (DEXA), magnetic resonance imaging, computerized tomography and neutron activation analysis. [3],[4],[5],[6],[7],[8] Each of these techniques is plagued with limitations. Either they are not bed side tools or the equipment is expensive or they are not feasible in clinical settings. Bioelectric impedance analysis (BIA) is a commonly used tool for estimating total, extracellular and intracellular water compartments in clinical and field studies. It is simple, inexpensive and portable and can be used as a bed side tool. A metaanalysis of published reports in which BIA techniques were used showed that multifrequency BIA did not significantly overestimate the TBW compared with the reference values for healthy and obese adults and for those with chronic renal failure. [9]

We studied 52 subjects randomly selected from the general population and we aimed at screening them for hypertension and chronic kidney disease (CKD). From the clinical investigations, of 52 subjects, 46.2% were mildly anemic, 38.5% had hypertension, 13.5% had diabetes mellitus and 7.7% had renal disease. Single-frequency BIA measurement, on the non-dominant side of the body, with a standard tetra-polar whole-body (hand-foot) technique was used. A bioelectrical impedance analyzer Maltron BIOSCAN analyzer 915/916 was used for evaluating the body composition, creatinine clearance and glomerular filtration rate (GFR). The parameters that were measured using BIA included resting metabolic rate, fat-free mass (FFM) and FFM percent, fat mass (FM) and FM percent and water compartments, which included TBW and TBW percent, extracellular water (ECW) and ECW percent, intracellular water (ICW) and ICW percent, ECW/ICW ratio, plasma fluid, extracellular fluid (EF) and interstitial fluid (IF), creatinine clearance and GFR. To validate BIA-derived TBW, BIA-derived TBW was compared with that derived using the equations by Hume et al: [10]

TBW in men = −14.01 + 0.2968 × body weigh + 0.1948 × height

TBW in women = −35.27 + 0.1838 × body weight + 0.3445 × height

where height is in centimeters and bodyweight is in kilograms. To validate the BIA-derived GFR, we compared the GFR estimated from the diethylene triamine pentaacetic acid nuclear scan of five patients. Values of GFR obtained from both tests were similar.

The mean age of the subjects was 51.3 ± 13.3. The BIA-derived resting metabolic rate for males was 1402 ± 196 and for females was 1220 ± 130. The mean of BIA-derived TBW was 33.7 ± 6.6 L and that derived using the Hume equation was 34.8 ± 6.18 L. There was no statistically significant difference between the two (P = 0.189). The mean creatinine clearance (calculated from the measured serum crea-tinine and BIA) was 97.4 ± 29.0 mL/min/1.73 m 2 . Based on GFR, we classified subjects into stages of CKD 1-5 (K/DOQI guidelines), [11] eight subjects were in CKD stage 1, 23 were in CKD stage 2, 18 were in CKD stage 3 and one each in CKD stage 4 and CKD stage 5, respectively. There was no significant difference in the creatinine clearance and GFR of males and females. There was no difference between actual weight and BIA-derived dry weight of the subjects.

The correlation analysis showed that systolic blood pressure (BP) had a negative correlation with TBW%, ECW% and ECW/ICW and a positive association with ICW and percent, creatinine clearance, GFR and dry weight. Diastolic BP had a positive association with ICW and IF.

A previous study has confirmed an association between BP and overhydration as assessed by BIA in stable post-transplant patients. [12] The present study suggests that at centers where BIA is not used in regular practice for evaluation of body composition, anthropometric equations by Hume and Weyer can also be used for the estimation of TBW. [9]

The bioelectrical impedance instrument used in our study is based not only on the principles of resistance and reactance of low-voltage electric current passed through fat, water and lean body mass but also uses data on age, sex, race, height, weight and serum creatinine. The advantage of using this analyzer is that while calculating creatinine clearance and GFR, it takes into consideration the entire physical body (water compartments, actual fat and lean body mass). Hence, if a patient is found to be having CKD, then the dry weight derived from this method can guide the physician regarding the use of diuretics if water compartments (BIA derived) are expanded and the patient can be advised regarding fluid restriction. We conclude that BIA is a non-invasive, efficient and reproducible tool for estimating water compartments, creatinine excretion and GFR. The advantage of using BIA as a screening tool includes also the measurement of dry weight of the subject; therefore, if a patient is in CKD stage 4, is retaining water and is not symptomatic (absence of edema), he can be evaluated further with BIA.

Conflict of interest: None

 
   References Top

1.
Chumlea WC, Guo SS, Zeller CM, et al. Total body water reference values and prediction equations for adults. Kidney Int 2001;59:2250-8.  Back to cited text no. 1
    
2.
Charra B, Laurent G, Chazot C, et al. Clinicalassessment of dry weight. Nephrol Dial Transplant 1996;11 Suppl 2:16-9.  Back to cited text no. 2
    
3.
Woodrow G, Oldroyd B, Turney JH, Tompkins L, Brownjohn AM, Smith MA. Whole body and regional body composition in patients with chronic renal failure. Nephrol Dial Transplant 1996;11:1613-8.  Back to cited text no. 3
    
4.
Woodrow G, Oldroyd B, Turney JH, Davies PS, Day JM, Smith MA. Measurement of total body water by bioelectrical impedance in chronic renal failure. Eur J Clin Nutr 1996; 50:676-81.  Back to cited text no. 4
    
5.
Kamimura MA, José Dos Santos NS, Avesani CM, Fernandes Canziani ME, Draibe SA, Cuppari L. Comparison of three methods for the determination of body fat in patients on long-term hemodialysis therapy. J Am Diet Assoc 2003;103:195-9.  Back to cited text no. 5
    
6.
Dumler F. Use of bioelectric impedance analysis and dual-energy X-ray absorptiometry for monitoring the nutritional status of dialysis patients. ASAIO J 1997;43:256-60.  Back to cited text no. 6
    
7.
Cooper BA, Aslani A, Ryan M, et al. Comparing different methods of assessing body composition in end-stage renal failure. Kidney Int 2000;58:408-16.  Back to cited text no. 7
    
8.
Jha V, Jairam A, Sharma MC, Sakhuja V, Piccoli A, Parthasarathy S. Body composition analysis with bioelectric impedance in adult Indians with ESRD: Comparison with healthy population. Kidney Int 2006;69:1649-53.  Back to cited text no. 8
    
9.
Martinoli R, Mohamed EI, Maiolo C, et al. Total body water estimation using bioelectrical impedance: A meta-analysis of the data available in the literature. Acta Diabetol 2003;40 Suppl 1:S203-6.  Back to cited text no. 9
    
10.
Hume R, Weyers E. Relationship between total body water and surface area in normal and obese subjects. J Clin Pathol 1971;24:234-8.  Back to cited text no. 10
[PUBMED]    
11.
KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Part 4. Definition and classification of stages of chronic kidney disease. 2002;39:S1-266  Back to cited text no. 11
    
12.
Saxena A, Sharma RK, Gupta A. Association of water compartments with hypertension in non-edematous renal transplant recipients. Indian J Transplant 2012;6:39-45.  Back to cited text no. 12
    

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Correspondence Address:
Dr. Anita Saxena
Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow
India
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DOI: 10.4103/1319-2442.168697

PMID: 26586080

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