Bioelectrical impedance analysis as a nutritional assessment tool in Autosomal Dominant Polycystic Kidney Disease

Hyunjin Ryu; Hayne Cho Park; Hyunsuk Kim; Jongho Heo; Eunjung Kang; Young-Hwan Hwang; Jeong Yeon Cho; Kyu-Beck Lee; Yun Kyu Oh; Kook-Hwan Oh; Curie Ahn

doi:10.1371/journal.pone.0214912

Bioelectrical impedance analysis as a nutritional assessment tool in Autosomal Dominant Polycystic Kidney Disease

PLoS One. 2019 Apr 4;14(4):e0214912. doi: 10.1371/journal.pone.0214912. eCollection 2019.

Authors

Hyunjin Ryu¹, Hayne Cho Park², Hyunsuk Kim³, Jongho Heo⁴, Eunjung Kang¹, Young-Hwan Hwang⁵, Jeong Yeon Cho⁶, Kyu-Beck Lee⁷, Yun Kyu Oh⁸, Kook-Hwan Oh^{1

9}, Curie Ahn^{1

9}

Affiliations

¹ Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
² Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
³ Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea.
⁴ National Assembly Futures Institute, Seoul, South Korea.
⁵ Truewords Dialysis Clinic, Incheon, Korea.
⁶ Department of Radiology, Seoul National University Hospital, Seoul, Korea.
⁷ Department of Internal Medicine, Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul, Korea.
⁸ Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
⁹ Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Abstract

Objective: Autosomal dominant polycystic kidney disease (ADPKD) patients with massive organomegaly suffer from pressure-related complications including malnutrition. In this study, we analyzed the efficacy of segmental bioelectrical impedance analysis (BIA) for objective and quantitative nutritional assessment in ADPKD patients.

Design and methods: We conducted a cross-sectional study, to evaluate the clinical utility of segmental BIA for assessing the nutritional status of ADPKD patients. BIA measurements was assessed according to modified subjective global assessment (SGA) scores and were compared with data from a healthy population. The association between BIA measurements and the height adjusted kidney and liver volumes (htTKLV), were analyzed.

Subjects: A total of 288 ADPKD patients, aged ≥ 18 years old, were analyzed.

Main outcome measures: Nutritional status was evaluated with SGA and segmental BIA. The htTKLV were measured in each patients using computed tomonography images.

Results: Higher ratios of extracellular water to total body water (ECW/TBW) in the whole-body (ECW/TBWWB), trunk (ECW/TBWTR), and lower extremities (ECW/TBWLE) and lower phase angle of lower extremities (PhALE) correlated with lower SGA scores in the ADPKD population and in both gender. The four parameters, ECW/TBWWB, ECW/TBWTR, and ECW/TBWLE of >0.38 and PhALE of <5.8 θ were associated with malnutrition in ADPKD patients. These correlations were preserved in the subgroup analysis for chronic kidney disease stages 1-3A. Compared to healthy populations' data, body fluid parameters and segmental ECW/TBW values, except for the upper extremities (ECW/TBWUE), were greater in ADPKD patients. Increased htTKLV was an independent risk factor for malnutrition in ADPKD. The highest correlation with htTKLV was observed for the ECW/TBWTR (r = 0.466), followed by ECW/TBWWB (r = 0.407), ECW/TBWLE (r = 0.385), PhALE (r = -0.279), and PhATR (r = 0.215).

Conclusions: These results demonstrated that segmental BIA parameters of ECW/TBWWB, ECW/TBWTR, ECW/TBWLE and PhALE provide useful information on nutritional status including the impact of organomegaly in ADPKD.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Body Height*
Cross-Sectional Studies
Electric Impedance*
Female
Humans
Kidney / pathology*
Liver / pathology*
Male
Middle Aged
Nutrition Assessment*
Organ Size
Polycystic Kidney, Autosomal Dominant / pathology*
Sex Factors

Grants and funding

This work was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea (grant number: HI12C0014) and Korea Centers for Disease Control and Prevention (2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, and 2016E3300200).