Kidney Res Clin Pract  
Changes in bioimpedance analysis components before and after hemodialysis
Hyunsuk Kim1, Gwang Ho Choi1, Kwang Eon Shim1, Jung Hoon Lee1, Nam Ju Heo2, Kwon-Wook Joo3, Jong-Woo Yoon1, Yun Kyu Oh4
1Division of Nephrology, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
2Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
3Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
4Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
Correspondence to: Yun Kyu Oh
Department of Internal Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea.
Received: April 23, 2018; Revised: August 14, 2018; Accepted: August 21, 2018; Published online: November 19, 2018.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: This study compared nutritional parameters in hemodialysis (HD) subjects and controls using bioimpedance analysis (BIA) and investigated how BIA components changed before and after HD.
Methods: This cross-sectional study included 147 subjects on maintenance HD from two hospitals and 298 propensity score-matched controls from one healthcare center. BIA was performed pre- and post-HD at mid-weekdialysis sessions.
Results: Extracellular water/total body water (ECW/TBW) and waist-hip ratio were higher in the HD patients; the other variables were higher in the control group. The cardiothoracic ratio correlated best with overhydration (r = 0.425, P < 0.01) in HD subjects. Blood pressure, hemoglobin, creatinine, and uric acid positively correlated with the lean tissue index in controls; however, most of these nutritional markers did not show significant correlations in HD subjects. Normal hydrated weight was predicted to be higher in the pre-HD than post-HD measurements. Predicted ultrafiltration (UF) volume difference based on pre- and post-HD ECW/TBW and measured UF volume difference showed a close correlation (r 2 = 0.924, P < 0.01). Remarkably, the leg phase angle increased in the post-HD period.
Conclusion: The estimated normal hydrated weight using ECW/TBW can be a good marker for determining dry weight. HD subjects had higher ECW/TBW but most nutritional indices were inferior to those of controls. It was possible topredict UF volume differences using BIA, but the post-HD increase in leg phase angle, a nutritional marker, must be interpreted with caution.
Keywords: Bioimpedance, Hemodialysis, Lean tissue index, Nutritional status, Overhydration


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