Iranian journal of kidney diseases · 2025
Calf Bioimpedance Analysis: A Novel Approach for Evaluating Hydration Status in Pediatric Dialysis Patients Under High Dialysate Sodium.
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Firouzmand Mohammad, Noori Shahrokh, Nafisi Vahid Reza, Hooman Nakysa
Аннотация
INTRODUCTION: Assessment of hydration status in pediatric hemodialysis is complicated by dynamic fluid shifts and sodium variability. Conventional methods such as clinical evaluation and whole-body bioimpedance analysis (BIA) lack precision for individual-level monitoring. This study introduces a calf impedance ratio (ΔZ₁₅ₖₕ / ΔZ₁₅₀ₖₕ) to classify fluid responses and evaluate the impact of high dialysate sodium (143 mEq/L) on fluid dynamics and blood pressure.
METHODS: A cross-sectional study was conducted involving 14 children aged 5-12 years undergoing maintenance hemodialysis. Impedance was measured pre- and post-dialysis at two frequencies using a custom-built device. The raw impedance changes were analyzed without conversion to fluid volumes, allowing for classification into three physiological response groups based on the impedance ratio.
RESULTS: Three distinct physiological profiles emerged. Group1 (ΔZΔZ150kh15kh > 1) showed effective extracellular fluid removal with stable hemodynamics. Group 2 (ratio between 0 and 1) reflected minimal Extracellular Water (ECW) ECW changes, potentially due to sodium-driven redistribution, with additional influence from sodium-enhanced tissue conductivity. Group 3 (ΔZ₁₅ₖₕ < 0) exhibited paradoxical impedance decreases despite fluid removal,along with sodium increase and blood pressure elevation. ΔZ₁₅ₖₕpositively correlated with ΔBP-sys (r = 0.650, P = .012).
CONCLUSION: The impedance ratio (ΔZΔZ150kh15kh ) provides a sensitive index for classifying fluid responses and identifying sodium-related effects in pediatric hemodialysis. It may support individualized dialysis prescriptions by guiding adjustments in ultrafiltration and dialysate sodium to improve hemodynamic stability and fluid balance.
METHODS: A cross-sectional study was conducted involving 14 children aged 5-12 years undergoing maintenance hemodialysis. Impedance was measured pre- and post-dialysis at two frequencies using a custom-built device. The raw impedance changes were analyzed without conversion to fluid volumes, allowing for classification into three physiological response groups based on the impedance ratio.
RESULTS: Three distinct physiological profiles emerged. Group1 (ΔZΔZ150kh15kh > 1) showed effective extracellular fluid removal with stable hemodynamics. Group 2 (ratio between 0 and 1) reflected minimal Extracellular Water (ECW) ECW changes, potentially due to sodium-driven redistribution, with additional influence from sodium-enhanced tissue conductivity. Group 3 (ΔZ₁₅ₖₕ < 0) exhibited paradoxical impedance decreases despite fluid removal,along with sodium increase and blood pressure elevation. ΔZ₁₅ₖₕpositively correlated with ΔBP-sys (r = 0.650, P = .012).
CONCLUSION: The impedance ratio (ΔZΔZ150kh15kh ) provides a sensitive index for classifying fluid responses and identifying sodium-related effects in pediatric hemodialysis. It may support individualized dialysis prescriptions by guiding adjustments in ultrafiltration and dialysate sodium to improve hemodynamic stability and fluid balance.