Abstract：
Fluid overload is associated with morbidity and mortality in children receiving dialysis. Accurate clinical assessment is difficult, and using deuterium oxide (D2O) to measure total body water (TBW) is impractical. We investigated the use of ultrasound (US), bioimpedance spectroscopy (BIS), and anthropometry to assess fluid removal in children receiving maintenance hemodialysis (HD).
Participants completed US, BIS, and anthropometry immediately before and 1-2 h after HD for up to five sessions. US measured inferior vena cava (IVC) diameter, lung B-lines, muscle elastography, and dermal thickness. BIS measured the volume of extracellular (ECF) and intracellular (ICF) fluid. Anthropometry included mid-upper arm, calf and ankle circumferences, and triceps skinfold thickness. D2O was performed once pre-HD. We assessed the change in study measures pre- versus post-HD, and the correlation of change in study measures with percent change in body weight (%∆BW). We also assessed the agreement between TBW measured by BIS and D2O.
Eight participants aged 3.4-18.5 years were enrolled. Comparison of pre- and post-HD measures showed significant decrease in IVC diameters, lung B-lines, dermal thickness, BIS %ECF, mid-upper arm circumference, ankle, and calf circumference. Repeated measures correlation showed significant relationships between %∆BW and changes in BIS ECF (rrm =0.51, 95% CI 0.04, 0.80) and calf circumference (rrm=0.80, 95% CI 0.51, 0.92). BIS TBW correlated with D2O TBW but overestimated TBW by 2.2 L (95% LOA, -4.75 to 0.42).
BIS and calf circumference may be helpful to assess changes in fluid status in children receiving maintenance HD. IVC diameter, lung B-lines and dermal thickness are potential candidates for future studies.
Participants completed US, BIS, and anthropometry immediately before and 1-2 h after HD for up to five sessions. US measured inferior vena cava (IVC) diameter, lung B-lines, muscle elastography, and dermal thickness. BIS measured the volume of extracellular (ECF) and intracellular (ICF) fluid. Anthropometry included mid-upper arm, calf and ankle circumferences, and triceps skinfold thickness. D2O was performed once pre-HD. We assessed the change in study measures pre- versus post-HD, and the correlation of change in study measures with percent change in body weight (%∆BW). We also assessed the agreement between TBW measured by BIS and D2O.
Eight participants aged 3.4-18.5 years were enrolled. Comparison of pre- and post-HD measures showed significant decrease in IVC diameters, lung B-lines, dermal thickness, BIS %ECF, mid-upper arm circumference, ankle, and calf circumference. Repeated measures correlation showed significant relationships between %∆BW and changes in BIS ECF (rrm =0.51, 95% CI 0.04, 0.80) and calf circumference (rrm=0.80, 95% CI 0.51, 0.92). BIS TBW correlated with D2O TBW but overestimated TBW by 2.2 L (95% LOA, -4.75 to 0.42).
BIS and calf circumference may be helpful to assess changes in fluid status in children receiving maintenance HD. IVC diameter, lung B-lines and dermal thickness are potential candidates for future studies.
摘要：
背景：液体超负荷与接受透析的儿童的发病率和死亡率相关。准确的临床评估是困难的，使用氧化氘（D2O）测量总体内水（TBW）是不切实际的。我们调查了超声波的使用（美国），生物阻抗谱（BIS），和人体测量学来评估接受维持性血液透析（HD）的儿童的液体清除情况。
方法：参与者完成了美国，BIS,在HD之前和之后1-2小时进行人体测量，最多可进行五次。美国测量下腔静脉（IVC）直径，肺B线，肌肉弹性成像,和真皮厚度。BIS测量细胞外(ECF)和细胞内(ICF)流体的体积。人体测量包括上臂中部，小腿和脚踝的围,和三头肌皮褶厚度。D2O在HD前进行一次。我们评估了HD前后研究指标的变化，以及研究指标变化与体重变化百分比(%ΔBW)的相关性。我们还评估了通过BIS和D2O测量的TBW之间的一致性。
结果：招募了8名年龄在3.4-18.5岁的参与者。比较前和后HD测量显示IVC直径显着下降，肺B线，真皮厚度,BIS%ECF,中上臂周长,脚踝,和小腿周长。重复测量相关性显示，BW%与BISECF(rrm=0.51，95%CI0.04，0.80)和小腿周长(rrm=0.80，95%CI0.51，0.92)的变化之间存在显著关系。BISTBW与D2OTBW相关，但高估了TBW2.2升(95%LOA，-4.75至0.42）。
结论：BIS和小腿围可能有助于评估接受维持性HD的儿童的体液状态变化。IVC直径,肺B线和真皮厚度是未来研究的潜在候选者.
方法：参与者完成了美国，BIS,在HD之前和之后1-2小时进行人体测量，最多可进行五次。美国测量下腔静脉（IVC）直径，肺B线，肌肉弹性成像,和真皮厚度。BIS测量细胞外(ECF)和细胞内(ICF)流体的体积。人体测量包括上臂中部，小腿和脚踝的围,和三头肌皮褶厚度。D2O在HD前进行一次。我们评估了HD前后研究指标的变化，以及研究指标变化与体重变化百分比(%ΔBW)的相关性。我们还评估了通过BIS和D2O测量的TBW之间的一致性。
结果：招募了8名年龄在3.4-18.5岁的参与者。比较前和后HD测量显示IVC直径显着下降，肺B线，真皮厚度,BIS%ECF,中上臂周长,脚踝,和小腿周长。重复测量相关性显示，BW%与BISECF(rrm=0.51，95%CI0.04，0.80)和小腿周长(rrm=0.80，95%CI0.51，0.92)的变化之间存在显著关系。BISTBW与D2OTBW相关，但高估了TBW2.2升(95%LOA，-4.75至0.42）。
结论：BIS和小腿围可能有助于评估接受维持性HD的儿童的体液状态变化。IVC直径,肺B线和真皮厚度是未来研究的潜在候选者.
