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Kidney Week

Abstract: PO2309

Clinical Relevance of Fluid Volume Status Assessment by Bioimpedance Spectroscopy in Children on Maintenance Dialysis

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Min, Jeesu, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Park, Peong Gang, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Kim, Ji hyun, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Ahn, Yo Han, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Ha, IL-Soo, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Kang, Hee Gyung, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
Background

Bioimpedance spectroscopy (BIS) has been used as a noninvasive method to evaluate body fluid volume status in dialysis patients. However, reports in pediatric dialysis patients about the effectiveness of this method are rare. We asked if there is a correlation in the results of BIS and clinical characteristics, and if there is a subsequent change of cardiovascular characteristics in patients whose dialysis prescription was modified based on BIS.

Methods

Medical records of children on maintenance dialysis who were evaluated by multifrequency BIS between January 2016 and December 2019 were reviewed. Their first result of BIS was assessed and fluid overload status was correlated with hypertension, number of oral antihypertensive medications and echocardiography results. In patients with fluid overload, change of dialysis prescription and clinical characteristics over time were reviewed.

Results

Among the 47 patients (male:female 28:19, hemodialysis:peritoneal dialysis 17:30) with a median age of 13.5 years, 13 children were overhydrated with the proportional overhydration relative to extracellular water more than 15%. Majority of children (76.9%) with fluid overload were taking two or more oral antihypertensive medications, while less than half of those without fluid overload were. 11 out of 13 overhydrated children changed their dialysis prescription to reduce their target body weights. Subsequent BIS in overhydrated children revealed a significantly decreased amount of fluid overload (initial: median 22.9%, follow-up: median 13.4%). However, their mean blood pressure (initial: 89.8 mmHg, follow-up: 84 mmHg) and the number of antihypertensive medications [initial: median 2 (0-4), follow-up: median 2 (0-5)] did not significantly change. Also, none of the children initially overhydrated had their left ventricle hypertrophy changed.

Conclusion

While BIS might be a useful and noninvasive method to assess fluid status, implementation of this tool did not lead to clinically meaningful improvement of cardiovascular characteristics in the children on maintenance dialysis. Long-term follow-up of a larger population and correlation with a more objective clinical indicator of fluid overload such as serum brain natriuretic peptide would be necessary to verify the clinical effectiveness of BIS in pediatric dialysis patients.