title: Bioimpedance and Fluid Status in Children and Adolescents Treated With Dialysis.
abstract: BACKGROUND
  Assessment of hydration status in patients with chronic kidney failure treated by dialysis is crucial for clinical management decisions. Dilution techniques are considered the gold standard for measurement of body fluid volumes, but they are unfit for day-to-day care. Multifrequency bioimpedance has been shown to be of help in clinical practice in adults and its use in children and adolescents has been advocated. We investigated whether application of multifrequency bioimpedance is appropriate for total-body water (TBW) and extracellular water (ECW) measurement in children and adolescents on dialysis therapy.
  
  
  METHODS
  A study of diagnostic test accuracy.
  
  
  METHODS
  16 young dialysis patients (before a hemodialysis session or after peritoneal dialysis treatment) from the Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, and the Emma Children's Hospital-Academic Medical Center, Amsterdam, the Netherlands.
  
  
  METHODS
  TBW and ECW volumes assessed by multifrequency bioimpedance.
  
  
  METHODS
  TBW and ECW volumes measured by deuterium and bromide dilution, respectively.
  
  
  RESULTS
  Mean TBW volumes determined by multifrequency bioimpedance and deuterium dilution were 19.2±8.7 (SD) and 19.3±8.3L, respectively; Bland-Altman analysis showed a mean bias between the 2 methods of -0.09 (95% limits of agreement, -2.1 to 1.9) L. Mean ECW volumes were 8.9±4.0 and 8.3±3.3L measured by multifrequency bioimpedance and bromide dilution, respectively; mean bias between the 2 ECW measurements was +0.6 (95% limits of agreement, -2.3 to 3.5).
  
  
  CONCLUSIONS
  Participants ingested the deuterated water at home without direct supervision by investigators, small number of patients, repeated measurements in individual patients were not performed.
  
  
  CONCLUSIONS
  Multifrequency bioimpedance measurements were unbiased but imprecise in comparison to dilution techniques. We conclude that multifrequency bioimpedance measurements cannot precisely estimate TBW and ECW in children receiving dialysis.
authors.affiliation: Department of Pediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: milani.gregoriop@gmail.com.
authors.forename: Gregorio P
authors.initials: GP
authors.lastname: Milani
authors.affiliation: Pediatric Nephrology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Groothoff
authors.affiliation: Department of Pediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Federica A
authors.initials: FA
authors.lastname: Vianello
authors.affiliation: Department of Pediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Emilio F
authors.initials: EF
authors.lastname: Fossali
authors.affiliation: Department of Pediatric Nephrology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Paglialonga
authors.affiliation: Department of Pediatric Nephrology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
authors.affiliation: Department of Pediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Agostoni
authors.affiliation: Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.affiliation: Pediatrics, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Dewi
authors.initials: D
authors.lastname: van Harskamp
authors.affiliation: Pediatrics, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; Pediatrics VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Goudoever
authors.affiliation: Pediatrics, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: Schierbeek
authors.affiliation: Pediatric Nephrology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Michiel J S
authors.initials: MJ
authors.lastname: Oosterveld
mesh_terms: D000293:Adolescent; D001834:Body Water; D002648:Child; D002675:Child, Preschool; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007424:Intracellular Fluid; D008297:Male; D006435:Renal Dialysis
keywords: Hydration status; adolescents; body composition; body composition monitor (BCM); bromide dilution; children; deuterium dilution; extracellular water (ECW); fluid overload; fluid status; hemodialysis; isotope ratio mass spectrometry; multi-frequency bioimpedance measurement; pediatric; peritoneal dialysis; renal failure; stable isotopes; total body water (TBW)