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Development and Validation of Bioimpedance Analysis Prediction Equations for Dry Weight in Hemodialysis Patients

Carlo Basile^*, Luigi Vernaglione, Biagio Di Iorio, Vincenzo Bellizzi, Domenico Chimienti^*, Carlo Lomonte^*, Anna Rubino, and Nicola D'Ambrosio

^* Nephrology and Dialysis Units, "Miulli" General Hospital, and Gambro Health Care, Acquaviva delle Fonti, Nephrology and Dialysis Units, "Giannuzzi" Hospital, Manduria, and Nephrology and Dialysis Units, "Landolfi" Hospital, Solofra, Italy

Address correspondence to: Dr. Carlo Basile, Via C. Battisti 192, 74100 Taranto, Italy. Phone: +39-80-3054205; Fax: +39-80-762165; E-mail: basile.miulli{at}libero.it

Background: Accurate assessment of hydration status and specification of dry weight (DW) are major problems in the clinical treatment of hemodialysis (HD) patients. Bioelectrical impedance analysis (BIA) has been recognized as a noninvasive and simple technique for the determination of DW in HD patients.

Design, setting, participants, and measurements: This study was designed to develop and validate BIA prediction equations for DW in HD patients. It included white adults (1540 disease-free adults with normal body mass index [BMI] and 456 prevalent and 27 incident HD patients). All participants underwent at least one single-frequency BIA measurement (800 µA and 50 kHz alternating sinusoidal current with a standard tetrapolar technique). The BIA variable measured was resistance (R). Data of 1463 (95% of the cohort) disease-free individuals with normal BMI (prediction sample) were used to establish best-fitting BIA prediction equations of body weight. The latter were cross-validated in the residual 5% subset (77 individuals) of the same cohort (validation sample).

Results: Multiple regression analysis showed a significant relationship among body weight, R, age, and height in 739 men (R² = 0.82, P < 0.0001) and among body weight, R, and height in 724 women (R² = 0.68, P < 0.0001) in the prediction sample. The Bland Altman analysis showed a mean difference between predicted and measured body weight of 0.3 ± 1.0 kg (95% confidence interval ± 2.0 kg) in the validation sample. The BIA prediction equations that were obtained in disease-free individuals with normal BMI were applied to a cohort of 456 prevalent HD patients: The mean difference between achieved and estimated DW was 0.1 ± 1.0 kg (P = 0.53) in men and –0.3 ± 1.0 (P = 0.76) in women. Finally, BIA prediction equations were tested in a cohort of 27 incident HD patients. The mean difference between predicted and achieved DW was –0.6 ± 1.0 kg (P = 0.76) in men and 0.6 ± 1.0 (P = 0.50) in women.

Conclusions: This study was able to develop and validate BIA prediction equations for DW in HD patients. They seem to be a promising tool; however, they still need external validation.