Application of bioimpedance analysis in patients with chronic kidney disease for fluid management and nutritional status assessment.

Abstract

Chronic Kidney Disease (CKD), especially its end-stage (ESRD) requiring renal replacement therapy, is associated with significant morbidity and mortality. Two critical and interconnected management challenges in this population are the accurate assessment of hydration status and nutritional status. Fluid overload (FO) is a strong independent predictor of cardiovascular events and all-cause mortality in dialysis patients. Conversely, underestimation of dry weight leads to intradialytic complications. Clinical assessment of dry weight is often imprecise. Malnutrition and protein-energy wasting (PEW) are equally prevalent and detrimental, complicating the clinical picture. Traditional tools like clinical examination, body mass index (BMI), and serum albumin have limitations in differentiating between fat, muscle mass, and fluid compartments. Bioimpedance analysis (BIA) is a non invasive, reproducible, and relatively inexpensive bedside technique that estimates body composition by measuring the resistance and reactance of the body to a low level alternating electrical current. It provides quantitative data on total body water (TBW), extracellular water (ECW), intracellular water (ICW), and body cell mass (BCM). This thesis explores the application and utility of various BIA methodologies in the comprehensive management of patients with CKD.