The Sensitivity of Bioimpedance to Assess Leg Fluid Volume Changes in Children on Hemodialysis: Experimental and Model-Based Investigation
DOI:
https://doi.org/10.61882/ijkd.19.04.8556Keywords:
Bioimpedance, Hemodialysis, Pediatric, Electrode Placement, Fluid AssessmentAbstract
Introduction. Fluid management plays an essential role in pediatric hemodialysis; however, traditional assessment techniques often lack the precision required for this patient population. Bioimpedance analysis (BIA) offers a non-invasive alternative, but electrode placement significantly impacts measurement sensitivity. This study compared the efficacy of two calf-based electrode configurations — dorsal (ankle) versus plantar (sole) — in detecting fluid volume changes via bioimpedance in pediatric patients, particularly in terms of their sensitivity. Additionally, we evaluated a novel ring electrode arrangement for optimizing sensitivity distribution in lower limb tissues.
Methods. This controlled before-and-after study was conducted at the dialysis unit of Ali Asghar Children’s hospital in Tehran, Iran. It evaluated thirteen children (aged 3-15 years) undergoing hemodialysis using bioimpedance analysis. The primary outcome measure was the change in impedance values before and after a single dialysis session. Measurements were performed with electrodes placed in two configurations: between the plantar surface of the foot to below the knee (down), and between the ankle dorsal surface to below the knee (up). Current distribution patterns were modeled using COMSOL simulations.
Results. Mean ultrafiltration volume was 1123 ± 384 mL per session. Impedance changes were observed in both dorsal and plantar electrode configurations, with no significant differences or superiority in measuring these changes. Sensitivity analysis revealed variations of 35% with dorsal placement, 24% with plantar placement, and 20% with ring electrode configuration, demonstrating superior uniformity of the ring design across tissue regions.
Conclusion. Optimal electrode placement varies among patients with no universal advantage for either position. Bioimpedance sensitivity depends on location of fluid accumulation, and enhanced sensitivity is required for monitoring changes below two liters. The ring electrodes provided the most uniform sensitivity distribution. These findings support use of personalized bioimpedance monitoring approaches to improve fluid management precision in pediatric hemodialysis.
Downloads
References
1. Fischbach M, Zaloszyc A, Shroff R. The interdialytic weight gain: a simple marker of left ventricular hypertrophy in children on chronic haemodialysis. doi:10.1007/s00467
2. Jia M. The relationship of volume overload and its control to hypertension in hemodialysis patients. Physiol Behav. 2017;176(3):139-148. doi:10.1111/sdi.12838.The
3. Jaeger JQ, Mehta RL. Assessment of dry weight in hemodialysis: an overview. Journal of the American Society of Nephrology. 1999;10(2):392-403.
4. Simini F, Bertemes-Filho P. Bioimpedance in Biomedical Applications and Research.; 2018. doi:10.1007/978-3-319-74388-2
5. Seoane F, Abtahi S, Abtahi F, et al. Mean expected error in prediction of total body water: A true accuracy comparison between bioimpedance spectroscopy and single frequency regression equations. Biomed Res Int. 2015;2015. doi:10.1155/2015/656323
6. Davies SJ, Davenport A. The role of bioimpedance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients. Kidney Int. 2014;86:489-496. doi:10.1038/ki.2014.207
7. Chauhan R. Wearable Embedded System Design and Development for Hydration Monitoring via Bio impedance Analysis. Turkish Journal of Computer and Mathematics Education (TURCOMAT). 2018;9(3):1032-1039. doi:10.17762/turcomat.v9i3.13891
8. Usman M, Thapa S, Gupta AK, Xue W. Ring Based Wearable Bioelectrical Impedance Analyzer for Body Fat Estimation. In: 2018 IEEE International Symposium on Signal Processing and Information Technology (ISSPIT). 2018:291-296. doi:10.1109/ISSPIT.2018.8642675
9. Zhu F, Levin NW. Estimation of body composition and normal fluid status using a calf bioimpedance technique. In: Blood Purification. Vol 39. S. Karger AG; 2015:25-31. doi:10.1159/000368937
10. Seibert E, Müller SG, Fries P, et al. Calf bioimpedance spectroscopy for determination of dry weight in hemodialysis patients: Effects on hypertension and left ventricular hypertrophy. Kidney Blood Press Res. 2013;37(1):58-67. doi:10.1159/000343400
11. Seibert E, Zhu F, Kuhlmann MK, et al. Slope analysis of blood volume and calf bioimpedance monitoring in hemodialysis patients. Nephrology Dialysis Transplantation. 2012;27(12):4430-4436. doi:10.1093/ndt/gfr734
12. Diaz DH, Casas O, Pallas-Areny R. Heart rate detection from single-foot plantar bioimpedance measurements in a weighing scale. Annu Int Conf IEEE Eng Med Biol Soc. 2010;2010:6489-6492. doi:10.1109/IEMBS.2010.5627358
13. Jaffrin M, Bousbiat S. Accuracy of plantar electrodes compared with hand and foot electrodes in fat-free-mass measurement. J Healthc Eng. 2014;5(2):123-144. doi:10.1260/2040-2295.5.2.123
14. Iacopino L, Andreoli A, Innocente I, et al. Use of foot-to-foot bioelectrical impedance analysis in children. In: Acta Diabetologica. Vol 40. 2003. doi:10.1007/s00592-003-0068-0
15. Orsso CE, Gonzalez MC, Maisch MJ, Haqq AM, Prado CM. Using bioelectrical impedance analysis in children and adolescents: Pressing issues. Eur J Clin Nutr. 2022;76(5):659-665. doi:10.1038/s41430-021-01018-w
16. Gutiérrez-Marín D, Escribano J, Closa-Monasterolo R, et al. Validation of bioelectrical impedance analysis for body composition assessment in children with obesity aged 8-14y. Clinical Nutrition. 2021;40(6):4132-4139. doi:https://doi.org/10.1016/j.clnu.2021.02.001
17. Schotman JM, Borren MMGJ, Wetzels JFM, Kloke HJ, Reichert LJM, Boer H. Sensitivity of total body electrical resistance measurements in detecting extracellular volume expansion induced by infusion of NaCl 0 . 9 % Sensitivity of total body electrical resistance measurements in detecting extracellular volume expansion induced b. Eur J Clin Nutr. 2020;(August). doi:10.1038/s41430-020-0655-y
18. Bradbury MG, Smye SW, Brocklebank JT. Assessment of the sensitivity of bioimpedance to volume changes in body water. Pediatric Nephrology. 1995;9(3):337-340. doi:10.1007/BF02254204
19. Mobarak M, Researcher P. A Review Paper on the Sensitivity Analysis in Bioimpedance Measurement Technique. Vol 7.; 2022. doi:10.5281/zenodo.6604899
20. Nori, Shahrokh(IROST BED. MAH12 Bioimpedance Analyzer.; 2023.
21. Preedy VR. Handbook of Anthropometry: Physical Measures of Human Form in Health and Disease. Springer New York, NY; 2012. doi:10.1007/978-1-4419-1788-1
22. Gabriel S, Lau RW, Gabriel C. The dielectric properties of biological tissues: III. Parametric models for the dielectric spectrum of tissues. Phys Med Biol. 1996;41(11):2271-2293. doi:10.1088/0031-9155/41/11/003
23. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis - Part I: Review of principles and methods. Clinical Nutrition. 2004;23(5):1226-1243. doi:10.1016/j.clnu.2004.06.004
24. Rutkove S, Pacheck A, Sanchez B. Sensitivity distribution simulations of surface electrode configurations for electrical impedance myography HHS Public Access. doi:10.1002/mus.25561
25. Field AP. Discovering Statistics Using SPSS (and Sex and Drugs and Rock “n” Roll). SAGE; 2012.
26. Moissl U, Arias-Guillén M, Wabel P, et al. Bioimpedance-guided fluid management in hemodialysis patients. Clinical Journal of the American Society of Nephrology. 2013;8(9):1575-1582. doi:10.2215/CJN.12411212
27. Paglialonga F, Ardissino G, Galli MA, Scarfia R V., Testa S, Edefonti A. Bioimpedance analysis and cardiovascular status in pediatric patients on chronic hemodialysis. Hemodialysis International. 2012;16(SUPPL. 1). doi:10.1111/j.1542-4758.2012.00743.x
28. Schotman JM, Hazeleger LR, van Borren MMGJ, et al. Optimal current frequency for the detection of changes in extracellular water in patients on hemodialysis by measurement of total body electrical resistance. Clin Nutr ESPEN. 2021;43:302-307. doi:10.1016/j.clnesp.2021.03.035
29. Ozturk S, Taymez DG, Bahat G, et al. The influence of low dialysate sodium and glucose concentration on volume distributions in body compartments after haemodialysis: a bioimpedance analysis study. Nephrol Dial Transplant. 2008;23(11):3629-3634. doi:10.1093/ndt/gfn274
30. Mitsides N, McHugh D, Swiecicka A, et al. Extracellular resistance is sensitive to tissue sodium status; implications for bioimpedance-derived fluid volume parameters in chronic kidney disease. J Nephrol. 2020;33(1):119-127. doi:10.1007/s40620-019-00620-3
31. Sarkar S, Wystrychowski G, Zhu F, Usvyat L, Kotanko P, Levin N. Fluid Dynamics During Hemodialysis in Relationship to Sodium Gradient Between Dialysate and Plasma. ASAIO Journal. 2007;53:339-342. doi:10.1097/MAT.0b013e318033cba7
32. Mitsides N, Mchugh D, Swiecicka A, Mitra R, Brenchley P. Extracellular resistance is sensitive to tissue sodium status ; implications for bioimpedance derived fluid volume parameters in chronic kidney disease. J Nephrol. 2020;33(1):119-127. doi:10.1007/s40620-019-00620-3
33. Novak I, Davies PSW, Elliott MJ. Noninvasive estimation of total body water in critically ill children after cardiac operations: Validation of a bioelectric impedance method. J Thorac Cardiovasc Surg. 1992;104(3):585-589. doi:https://doi.org/10.1016/S0022-5223(19)34722-1
34. Cha K, Chertow G, Gonzalez J, Lazarus J, Wilmore D. Multifrequency bioelectrical impedance estimates the distribution of body water. J Appl Physiol. 1995;79 4:1316-1319. doi:10.1152/JAPPL.1995.79.4.1316
35. Rutkove SB, Pacheck A, Sanchez B. Sensitivity distribution simulations of surface electrode configurations for electrical impedance myography. Muscle Nerve. 2017;56(5):887-895. doi:10.1002/mus.25561
36. Sel K, Osman D, Huerta N, Edgar A, Pettigrew RI, Jafari R. Continuous cuffless blood pressure monitoring with a wearable ring bioimpedance device. NPJ Digit Med. 2023;6(1). doi:10.1038/s41746-023-00796-w
37. Osman D, Jankovic M, Sel K, Pettigrew R, Jafari R. Blood Pressure Estimation using a Single Channel Bio-Impedance Ring Sensor. 2022 44th Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC). Published online 2022:4286-4290. doi:10.1109/EMBC48229.2022.9871653
