Does the presence of an arteriovenous fistula alter changes in body water following hemodialysis as determined by multifrequency bioelectrical impedance assessment?
Multifrequency bioelectrical impedance assessments (MFBIAs) aid clinical assessment of hydration status for hemodialysis (HD) patients. Many MFBIA devices are restricted to whole body measurements and as many patients dialyze using arteriovenous fistulas (AVFs), we wished to determine whether AVFs affected body water measurements. We reviewed pre- and post-HD segmental MFBIA measurements in 229 patients attending for midweek HD sessions. Up to 144 were dialyzed with a left arm AVF (L-AVF), 42 with a right arm AVF (R-AVF), and 43 by central venous access catheter (CVC). Water content and lean tissue were greater in the left compared to right arm in those patients with L-AVFs both pre and post dialysis (pre 2.1 ± 0.7 vs. 2.0 ± 0.7 L, and post 1.9 ± 0.6 vs. 1.8 ± 0.6 L and pre 2.65 ± 0.9 vs. 2.56 ± 0.8 kg, and post 2.34 ± 0.8 vs. 2.48 ± 0.8 vs. 2.34 ± 0.8 kg, respectively) and were also greater in the right compared to left arm for those patients dialyzing with R-AVFs (pre-HD 1.92 ± 0.5 vs. 1.86 ± 0.6 L and post-HD 1.79 ± 0.5 vs. 1.7 ± 0.5 L, and pre-HD 2.47 ± 0.6 vs. 2.38 ± 0.7 kg and post-HD 2.3 ± 0.74 vs. 1.28 ± 0.7 kg, respectively), all Ps < 0.05. There were no significant differences in arm volumes or composition pre or post dialysis in those dialyzing with CVCs. Segmental MFBIA detects differences in arm water and lean mass in patients with AVFs. The presence on an AVF increases the water content in the ipsilateral arm both pre and post HD. This increased water content of the fistula arm will not be detected by whole body bioimpedance devices.
Department of Nephrology, Bumrungrad International Hospital, Bangkok, Thailand.
Kwanpeemai
K
Panorchan
Renal Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Arkom
A
Nongnuch
UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK.
Sally
S
El-Kateb
UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK.
Cate
C
Goodlad
UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK.
Andrew
A
Davenport
D001164:Arteriovenous Fistula / Q000150:complications*; D001166:Arteriovenous Shunt, Surgical; D001834:Body Water / Q000378:metabolism*; D062905:Central Venous Catheters / Q000706:statistics & numerical data*; D017097:Electric Impedance / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*
Bioimpedance; arteriovenous fistula; central venous catheter; extracellular water; hemodialysis; lean mass