TY - JOUR
T1 - Three compartment bioimpedance spectroscopy in the nutritional assessment and the outcome of patients with advanced or end stage kidney disease
T2 - What have we learned so far?
AU - Broers, Natascha J. H.
AU - Canaud, Bernard
AU - Dekker, Marijke J. E.
AU - van der Sande, Frank M.
AU - Stuard, Stefano
AU - Wabel, Peter
AU - Kooman, Jeroen P.
N1 - Publisher Copyright:
© 2020 The Authors. Hemodialysis International published by Wiley Periodicals, Inc. on behalf of International Society for Hemodialysis.
PY - 2020/4
Y1 - 2020/4
N2 - Bioimpedance spectroscopy (BIS) is an easily applicable tool to assess body composition. The three compartment model BIS (3C BIS) conventionally expresses body composition as lean tissue index (LTI) (lean tissue mass [LTM]/height in meters squared) and fat tissue index (FTI) (adipose tissue mass/height in meters squared), and a virtual compartment reflecting fluid overload (FO). It has been studied extensively in relation to diagnosis and treatment guidance of fluid status disorders in patients with advanced-stage or end-stage renal disease. It is the aim of this article to provide a narrative review on the relevance of 3C BIS in the nutritional assessment in this population. At a population level, LTI decreases after the start of hemodialysis, whereas FTI increases. LTI below the 10th percentile is a consistent predictor of outcome whereas a low FTI is predominantly associated with outcome when combined with a low LTI. Recent research also showed the connection between low LTI, inflammation, and FO, which are cumulatively associated with an increased mortality risk. However, studies toward nutritional interventions based on BIS data are still lacking in this population. In conclusion, 3C BIS, by disentangling the components of body mass index, has contributed to our understanding of the relevance of abnormalities in different body compartments in chronic kidney disease patients, and appears to be a valuable prognostic tool, at least at a population level. Studies assessing the effect of BIS guided nutritional intervention could further support its use in the daily clinical care for renal patients.
AB - Bioimpedance spectroscopy (BIS) is an easily applicable tool to assess body composition. The three compartment model BIS (3C BIS) conventionally expresses body composition as lean tissue index (LTI) (lean tissue mass [LTM]/height in meters squared) and fat tissue index (FTI) (adipose tissue mass/height in meters squared), and a virtual compartment reflecting fluid overload (FO). It has been studied extensively in relation to diagnosis and treatment guidance of fluid status disorders in patients with advanced-stage or end-stage renal disease. It is the aim of this article to provide a narrative review on the relevance of 3C BIS in the nutritional assessment in this population. At a population level, LTI decreases after the start of hemodialysis, whereas FTI increases. LTI below the 10th percentile is a consistent predictor of outcome whereas a low FTI is predominantly associated with outcome when combined with a low LTI. Recent research also showed the connection between low LTI, inflammation, and FO, which are cumulatively associated with an increased mortality risk. However, studies toward nutritional interventions based on BIS data are still lacking in this population. In conclusion, 3C BIS, by disentangling the components of body mass index, has contributed to our understanding of the relevance of abnormalities in different body compartments in chronic kidney disease patients, and appears to be a valuable prognostic tool, at least at a population level. Studies assessing the effect of BIS guided nutritional intervention could further support its use in the daily clinical care for renal patients.
KW - Bioimpedance spectroscopy
KW - body composition
KW - chronic kidney disease
KW - nutritional assessment
KW - BODY-COMPOSITION MONITOR
KW - ALL-CAUSE MORTALITY
KW - FLUID STATUS MEASUREMENTS
KW - INDEPENDENT RISK-FACTOR
KW - X-RAY ABSORPTIOMETRY
KW - LEAN TISSUE INDEX
KW - HEMODIALYSIS-PATIENTS
KW - PERITONEAL-DIALYSIS
KW - VISCERAL FAT
KW - MASS INDEX
U2 - 10.1111/hdi.12812
DO - 10.1111/hdi.12812
M3 - (Systematic) Review article
C2 - 31970883
SN - 1492-7535
VL - 24
SP - 148
EP - 161
JO - Hemodialysis international
JF - Hemodialysis international
IS - 2
ER -