Kidney Research and Clinical Practice 2019 Mar; 38(1): 71-80
Evaluation of different bioimpedance methods for assessing body composition in Asian non-dialysis chronic kidney disease patients
Sean WY Lee1, Clara Lee Ying Ngoh2, Horng Ruey Chua2, Sabrina Haroon2, Weng Kin Wong2, Evan JC Lee1,2, Titus WL Lau2, Sunil Sethi3, Boon Wee Teo1,2
1Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 2Division of Nephrology, Department of Medicine, National University Health System, Singapore, 3Department of Pathology, National University Health System, Singapore
Correspondence to: Boon Wee Teo, Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 10 NUHS Tower Block, Singapore 119 228, Singapore. E-mail:
Received: July 9, 2018; Revised: November 14, 2018; Accepted: December 1, 2018; Published online: March 31, 2019.
© The Korean Society of Nephrology. All rights reserved.

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Background: Chronic kidney disease (CKD) is associated with fluid retention, which increases total body water (TBW) and leads to changes in intracellular water (ICW) and extracellular water (ECW). This complicates accurate assessments of body composition. Analysis of bioelectrical impedance may improve the accuracy of evaluation in CKD patients and multiple machines and technologies are available. We compared body composition by bioimpedance spectroscopy (BIS) against multi-frequency bioimpedance analysis (BIA) in a multi-ethnic Asian population of stable, non-dialysis CKD patients.
Methods: We recruited 98 stable CKD patients comprising 54.1% men and 70.4% Chinese, 9.2% Malay, 13.3% Indian, and 8.2% other ethnicities. Stability was defined as no variation in serum creatinine > 20% over three months. Patients underwent BIS analyses using a Fresenius body composition monitor, while BIA analyses employed a Bodystat Quadscan 4000.
Results: Mean TBW values by BIS and BIA were 33.6 ± 7.2 L and 38.3 ± 7.4 L; mean ECW values were 15.8 ± 3.2 L and 16.9 ± 2.7 L; and mean ICW values were 17.9 ± 4.3 L and 21.0 ± 4.9 L, respectively. Mean differences for TBW were 4.6 ± 1.9 L (P < 0.001), for ECW they were 1.2 ± 0.5 L (P < 0.001), and for ICW they were 3.2 ±1.8 L (P < 0.001). BIA and BIS measurements were highly correlated: TBW r = 0.970, ECW r = 0.994, and ICW r = 0.926. Compared with BIA, BIS assessments of fluid overload appeared to be more associated with biochemical and clinical indicators.
Conclusion: Although both BIA and BIS can be used for body water assessment, clinicians should be aware of biases that exist between bioimpedance techniques. The values of body water assessments in our study were higher in BIA than in BIS. Ethnicity, sex, body mass index, and estimated glomerular filtration rate were associated with these biases.
Keywords: Adult, Body composition, Body water, Electric impedance, Kidney diseases, Nutrition assessment


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