Diagnostic Accuracy of Bioelectrical Impedance Analysis Parameters for the Evaluation of Malnutrition in Patients Receiving Hemodialysis

• Published in: Nutrition in clinical practice Vol. 33; no. 6; pp. 831 - 842
• Main Authors: da Silva, Angela Teodósio, Hauschild, Daniela Barbieri, Moreno, Yara Maria Franco, Bastos, João Luiz Dornelles, Wazlawik, Elisabeth
• Format: Journal Article
• Language: English
• Published: United States 01-12-2018
• Subjects: Adult; Aged; bioelectrical impedance; Body Composition; chronic renal insufficiency; Electric Impedance; Female; Humans; Kidney Failure, Chronic - complications; Male; Malnutrition - diagnosis; Malnutrition - etiology; Mass Screening; Middle Aged; Nursing; Nutrition Assessment; nutritional assessment; Nutritional Status; Reference Values; Renal Dialysis; Sensitivity and Specificity; Sex Factors; bioelectrical impedance; nutritional assessment; chronic renal insufficiency; renal dialysis
• ISSN: 0884-5336; 1941-2452
• DOI: 10.1002/ncp.10098

Background
In the absence of a gold standard technique for assessing nutrition status in patients receiving hemodialysis (HD), we aimed to determine the diagnostic accuracy of single‐frequency (50 kHz) bioelectrical impedance analysis parameters, resistance/height (R/H), reactance/height (Xc/H), and impedance/height (Z/H), and their cutoff points for malnutrition.
Methods
The reference standards, Subjective Global Assessment (SGA), Malnutrition Inflammation Score, and Nutritional Risk Screening 2002, were performed at baseline and then once a year for 2 years. At least 2 assessments for each reference standard were performed during the monitoring period, and those patients who were assessed as malnourished on at least 2 consecutive occasions were classified as malnourished.
Results
A total 101 patients receiving HD were evaluated. R/H and Z/H demonstrated low to moderate accuracy to diagnose malnutrition in men and low accuracy in women, whereas the accuracy of Xc/H was uncertain. The cutoff points of bioelectrical impedance vector analysis (BIVA) parameters, determined based on the SGA to maximize sensitivity and specificity simultaneously, were: R/H ≥330.05 and ≥420.92 ohms/m for men and women, respectively; Z/H ≥332.71 and ≥423.19 ohms/m for men and women, respectively. In men, sensitivity based on the cutoff points of R/H and Z/H together ranged from 73% to 89% and specificity ranged from 49% to 50%. In women, sensitivity ranged from 58% to 80% and specificity from 48% to 55%.
Conclusion
BIVA parameters demonstrated low to moderate accuracy in men and low accuracy in women for the diagnosis of malnutrition.