Abstract: FR-PO0490
Diagnostic Performance of the Extracellular Water/Total Body Water Ratio for Detecting Volume Overload in Patients on Hemodialysis
Session Information
- Dialysis: Hemodiafiltration, Ultrafiltration, Profiling, and Interdialytic Symptoms
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Perez-Navarro, L. Monserrat, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Mexico
- Martin Alemañy, Geovana, School of Nutritional Science and Wellness, The University of Arizona, Tuczon, Arizona, United States
- Wilund, Kenneth Robert, School of Nutritional Science and Wellness, The University of Arizona, Tuczon, Arizona, United States
- Reyes, Karina Elizabeth, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Mexico
- Galicia, Viridiana Galicia, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Mexico
- Valdez-Ortiz, Rafael, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Mexico
- García Villalobos, Gloria Guadalupe, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Mexico
Background
Volumen overload (VO) is a frequent and clinically significant complication in patients undergoing hemodialysis (HD). It is associated with increased cardiovascular morbidity and mortality. Accurate and accessible tools for early detection of VO are essential for guiding fluid management in this population. The ECW/TBW ratio, obtained through bioimpedance analysis, has been proposed as a potential marker, but its diagnostic value remains underexplored. Objective:To evaluate the diagnostic accuracy of the ECW/TBW ratio for detecting VO in HD patients.
Methods
Diagnostic test study. Body composition was measured using analysis SECA mBCA 525, 30 minutes after completing the HD session. Impedance vectors were analyzed using BIVA software to classify patients as either fluid overloaded or adequately hydrated. The ECW/TBW ratio was calculated, and ROC curve analysis was conducted to determine the area under the curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV, NPV), and likelihood ratios (LR+ and LR−). A 95% CI was used, and p-values ≤ 0.05 were considered significant.
Results
Data from 118 HD patients were included; 58% were women, with a mean age of 37.26 ± 14.8 years. The mean phase angle was 5.4 ± 1.25 and the ECW/TBW ratio was 0.44 ± 0.035. Based on BIVA stratification, 49% of patients had VO. The ECW/TBW ratio showed an AUC of 0.747 (p = 0.0001). Among several cutoffs tested, a ratio of 0.46 provided the best diagnostic performance, identifying 44% of patients with VO.
Conclusion
The ECW/TBW ratio is a practical and potentially effective marker for detecting VO in HD patients. Its simplicity makes it suitable for routine clinical use, although standardization and validation in specific populations are necessary. The choice of cutoff point should be guided by whether the test is used for screening (favoring sensitivity) or confirmation (favoring specificity).