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Both studies concluded that the BCM is an objective tool to define the hydration status in children. performed a longitudinal study comparing the BCM with the clinical judgments of volume status as assessed by peripheral and central aortic blood pressure as well as echocardiography and natriuretic peptide. validated the BCM in children for fluid status considering deuterium concentration decline and Urea Kinetic Modeling for comparison and Eng et al.
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The BCM was well-validated by invasive gold standard dilution methods using deuterium or tritium for total body water (TBW), bromide for extracellular water (ECW), and total body potassium for intracellular water (ICW). The calculations used for the body composition monitor (BCM, Fresenius Medical Care, Bad Homburg, Germany) are based on a physiologic tissue model. A better distinction between ECW and ICW appears to be obtained by multifrequency bioimpedance spectroscopy, the method used in the present investigation, because both the ECW and ICW might be modulated in patients with kidney disease. As indicated by Jaffrin et al., single frequency current will not penetrate completely into the cells and therefore does not measure the entire ICW. Among these techniques, whole-body, single- or multi-frequency bioimpedance spectroscopy are versatile noninvasive approaches for obtaining instant information about the body composition. Furthermore, the clinical assessment of fluid status does not allow distinguishing between intracellular and extracellular fluid volumes.įor several years, novel technologies have been in process to be developed for the quantitative assessment of the fluid status in humans. Until recently, the judgment of hydration status was by and large based on subjective clinical assessments, as no objective, easy-to-handle, and precise tools for measuring fluid compartments were available. For quantifying such quick changes, the methodology for measuring fluid status has to be noninvasive and versatile. The estimation of “dry weight” in a constantly growing organism is one of the most difficult challenges for the pediatric nephrologist. Fluid management is especially relevant in pediatric patients, because of the frequently quick changes of fluid volumes. Precise recognition of the fluid status is therefore of practical importance in kidney patients. Thus, and not surprisingly, cardiovascular diseases are an important cause of morbidity and mortality in patients with chronic kidney failure. Chronic hypervolemia induces hypertension and increased left ventricular mass. Patients with impaired kidney function have a high risk of chronic hypervolemia. The clinical utility of measuring TBW, ECW, and ICW should be defined in the future.
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ConclusionīCM quantifies TBW and acute changes of ECW and ICW in children with chronic kidney failure. The kinetics of fluid compartment changes assessed twice in six HD patients revealed a reproducible linear decay of the ECW/ICW ratio due to an increase of ICW and a decrease of ECW. The decline of overhydration during dialysis ( p < 0.001, n = 22) correlated with the change in body weight ( R 2 = 0.62). When compared with a healthy control group, TBW was increased in 9 TPL, 9 CKD, 1 PD, and 11 HD patients before but in none after dialysis. The ECW and ICW values obtained by BCM were of the same magnitude as those from the literature using isotope dilution. HD patients were investigated before, after, and sequentially during dialysis. Forty-two were transplanted (TPL), 43 suffered from chronic kidney disease without kidney replacement therapy (CKD), 21 were on peritoneal dialysis (PD), and 22 on hemodialysis (HD). Hydration was quantified using whole-body bioimpedance spectroscopy (BCM) in 128 outpatients (1–25 years, 52 girls). Here, we evaluate the hydration status in children with chronic kidney disease by analyzing TBW, ECW, and ICW. In clinical practice, the judgment of hydration status does not allow to distinguish between ECW and ICW. Total body water (TBW) is distributed between the extracellular (ECW) and intracellular fluid compartments (ICW). As a corollary, patients with impaired kidney function are prone to pathological fluid volumes. The kidney is central for maintaining water balance.