Korean J Crit Care Med.  2017 Aug;32(3):256-264. 10.4266/kjccm.2017.00136.

Utility of Volume Assessment Using Bioelectrical Impedance Analysis in Critically Ill Patients Receiving Continuous Renal Replacement Therapy: A Prospective Observational Study

• Park KH
• Shin JH
• Hwang JH
• Kim SH

• KMID: 2391185
• DOI: http://doi.org/10.4266/kjccm.2017.00136

Abstract

BACKGROUND
Fluid overload prior to continuous renal replacement therapy (CRRT) is an important prognostic factor. Thus, precise evaluation of fluid status is necessary to treat such patients. In this study, we investigated whether fluid assessment using bioelectrical impedance analysis (BIA) can predict outcomes in critically ill patients requiring CRRT.
METHODS
A prospective observational study was performed in patients who were admitted to the intensive care unit and who required CRRT. BIA was conducted before CRRT; then, the ratio of extracellular water to total body water (ECW/TBW) was derived to estimate volume status.
RESULTS
A total of 31 patients treated with CRRT were included. There were 18 men (58.1%), and the median age was 67 years (interquartile range, 51 to 78 years). Fourteen patients (45.2%) died within 28 days after CRRT initiation. Patients were divided into 16 with ECW/TBW ≥0.41 and 15 with ECW/TBW <0.41. Survival rate within 28 days was different between the two groups (P = 0.044). Cox regression analysis revealed a relationship between ECW/TBW ≥0.41 and 28-day mortality, but it was not statistically significant (hazard ratio, 3.0; 95% confidence interval, 0.9 to 9.8; P = 0.061). Lastly, the area under the curve of ECW/TBW for 28-day mortality was analyzed. The area under the curve of ECW/TBW was 0.73 (95% confidence interval, 0.54 to 0.92), and this was significant (P = 0.037).
CONCLUSIONS
Fluid status can be assessed using BIA in critically ill patients requiring CRRT, and BIA can predict mortality. Further large trials are needed to confirm the usefulness of BIA in critically ill patients.

Keyword

critical illness; electric impedance; mortality; renal replacement therapy

MeSH Terms

Body Water
Critical Illness*
Electric Impedance*
Humans
Intensive Care Units
Male
Mortality
Observational Study*
Prospective Studies*
Renal Replacement Therapy*
Survival Rate
Water
Water

Figure

• 

  Figure 1. Survival rate according to volume status in critically ill patients who received continuous renal replacement therapy. Survival rate was compared between the two groups. As shown, patients with ECW/TBW ≥0.41 had a lower survival rate than those with ECW/ TBW <0.41 (P = 0.044). Survival rate after 28 days was 73.3% in less hydrated patients and 36.0% in more hydrated patients. ECW/ TBW: the ratio of extracellular water to total body water.

• 

  Figure 2. Receiver operating characteristics curve of volume status estimated by bioelectrical impedance analysis. ECW/TBW appeared to have the potential to predict mortality (P = 0.037). The area under the curve of ECW/TBW for 28-day mortality was 0.73 (95% confidence interval, 0.54 to 0.92) in this study. ECW/ TBW: the ratio of extracellular water to total body water.

Reference

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