Introduction: Protein energy wasting is closely related to increased morbidity and mortality in peritoneal dialysis (PD) patients. Simple reliable and easily available methods of determining nutritional status and recognition of short-term changes in body composition are therefore important for clinical practice. Methods: We compared whole-body and segmental composition using multifrequency bioelectrical impedance analysis (MF-BIA) and dual-energy X-ray absorptiometry (DEXA) in 104 stable PD patients. Results: Assessment of whole-body composition showed that lean body mass (LBM) was highly correlated with good method agreement using DEXA as the reference test (r = 0.95, p < 0.0001; bias –0.88 kg, 95% CI –1.53 to 0.23 kg). Similarly, high correlation and good method agreement were found for fat mass (r = 0.93, p < 0.0001; bias 0.69 kg, 95% CI 0.03–1.36 kg). Segmental analysis of LBM revealed strong correlations between LBM for trunk, left and right arms and legs (r = 0.90, 0.84, 0.86, 0.89 and 0.90, respectively, p < 0.0001). Bone mineral content derived by MF-BIA overestimated that measured by DEXA (bias 0.740 kg, 95% CI 0.66–0.82 kg). Conclusion: MF-BIA may potentially be a useful tool for determining nutritional status in PD patients and serial estimations may help recognize short-term changes in body composition.

Keywords:
Fat, Dual-energy X-ray absorptiometry, Multifrequency bioimpedance, Muscle, Segmental body composition, Peritoneal dialysis, Nutrition
1.
K/DOQI, National Kidney Foundation: Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2000;35(suppl 2):S1–S140.
2.
Prasad N, Gupta A, Sinha A, Sharma RK, Saxena A, Kaul A, Bhaduria D, Gupta A: Confounding effect of comorbidities and malnutrition on survival of peritoneal dialysis patients. J Ren Nutr 2010;20:384–391.
3.
Bhatla B, Moore H, Emerson P, Keshaviah P, Prowant B, Nolph KD, Singh A: Lean body mass estimation by creatinine kinetics, bioimpedance, and dual energy x-ray absorptiometry in patients on continuous ambulatory peritoneal dialysis. ASAIO J 1995;41:M442–M446.
4.
Bishop CW, Bowen PE, Ritchey SJ: Norms for nutritional assessment of American adults by upper arm anthropometry. Am J Clin Nutr 1981;34:2530–2539.
5.
Morey B, Walker R, Davenport A: More dietetic time, better outcome? A randomized prospective study investigating the effect of more dietetic time on phosphate control in end-stage kidney failure haemodialysis patients. Nephron Clin Pract 2008;109:c173–c180.
6.
Durnin JV, Womersley J: Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 1974;32:77–97.
7.
Watson PE, Watson ID, Batt RD: Total body water volumes for adult males and females estimated from simple anthropometric measurements. Am J Clin Nutr 1980;33:27–39.
8.
Hume R, Weyers E: Relationship between total body water and surface area in normal and obese subjects. J Clin Pathol 1971;24:234–238.
9.
McCusker FX, Teehan BP, Thorpe KE, Keshaviah PR, Chuchill DN, for the Canada-USA (CANUSA) Peritoneal Dialysis Study Group: How much peritoneal dialysis is required for the maintenance of good nutritional state? Kidney Int 1996;50(suppl 56):S56–S61.
10.
Essig M, Vrtovsnik F: How to evaluate body composition in chronic kidney disease? Nephrol Ther 2008;4:92–98.
11.
Locatelli F, Fouque D, Heimburger O, Drüeke TB, Cannata-Andía JB, Hörl WH, Ritz E: Nutritional status in dialysis patients: a European consensus. Nephrol Dial Transplant 2002;17:563–572.
12.
Thomas EL, Frost G, Harrington T, Bell JD: Validation on ‘in-body’ bioelectrical impedance by whole-body MRI. Laboratory Report, 2001.
13.
Davenport A, Willicombe MK: Comparison of fluid status in patients treated by different modalities of peritoneal dialysis using multifrequency bioimpedance. Int J Artif Organs 2009;32:779–786.
14.
Davenport A, Willicombe MK: Hydration status does not influence peritoneal equilibration test ultrafiltration volumes. Clin J Am Soc Nephrol 2009;4:1207–1212.
15.
Bedogni G, Malavolti M, Severi S, Poli M, Mussi C, Fantuzzi AL, Battistini N: Accuracy of an 8-point tactile-electrode impedance method in the assessment of total body water. Eur J Clin Nutr 2002;56:1143–1148.
16.
Fürstenberg A, Davenport A: Comparison of multifrequency bioelectrical impedance analysis and dual-energy X-ray absorptiometry assessments in outpatient haemodialysis patients. Am J Kidney Dis 2011;57:123–129.
17.
Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307–310.
18.
Davies S: Renal Association Clinical Guidelines. Module 6: Peritoneal Dialysis. http://www.renal.org/Clinical/GuidelinesSection/Guidelines.aspx (accessed November 2010).
19.
Ho LC, Wang HH, Chiang CK, Hung KY, Wu KD: Malnutrition-inflammation score independently determined cardiovascular and infection risk in peritoneal dialysis patients. Blood Purif 2010;29:308–316.
20.
Negri AL, Barone R, Veron D, Fraga A, Arrizurieta E, Zucchini A, Zanchetta JR: Lean mass estimation by creatinine kinetics and dual-energy x-ray absorptiometry in peritoneal dialysis. Nephron Clin Pract 2003;95:c9–c14.
21.
Davenport A, Willicombe MK: Does diabetes mellitus predispose to increased fluid overload in peritoneal dialysis patients? Nephron Clin Pract 2009;114:c60–c66.
22.
Mendley SR, Majkowski NL, Schoeller DA: Validation of estimates of total body water in pediatric dialysis patients by deuterium dilution. Kidney Int 2005;67:2056–2062.
23.
Konings CJ, Kooman JP, Schonck M, Cox-Reijven PL, van Kreel B, Gladziwa U, Wirtz J, Gerlag PG, Hoorntje SJ, Wolters J, Heidendal GA, van der Sande FM, Leunissen KM: Assessment of fluid status in peritoneal dialysis patients. Perit Dial Int 2002;22:683–692.
24.
Konings CJ, Kooman JP, Schonck M, van Kreel B, Heidendal GA, Cheriex EC, van der Sande FM, Leunissen KM: Influence of fluid status on techniques used to assess body composition in peritoneal dialysis patients. Perit Dial Int 2003;23:184–190.
25.
Van de Kerkhof J, Konings CJ, van Kreel B, van der Sande FM, Leunissen KM, Kooman JP: Bioimpedance analysis and assessment of intracellular water in peritoneal dialysis patients. Perit Dial Int 2003;23:591–593.
26.
Genton L, Karsegard VL, Zawadynski S, Kyle UG, Pichard C, Golay A, Hans DB: Comparison of body weight and composition measured by two different dual-energy X-ray absorptiometry devices and three acquisition modes in obese women. Clin Nutr 2006;25:428–437.
27.
Schoeller DA, Tylavsky FA, Baer DJ, Chumlea WC, Earthman CP, Fuerst T, Harris TB, Heymsfield SB, Horlick M, Lohman TG, Lukaski HC, Shepherd J, Siervogel RM, Borrud LG: QDR 4500A dual-energy X-ray absorptiometer underestimates fat mass in comparison with criterion methods in adults. Am J Clin Nutr 2005;81:1018–1025.
28.
Foster KR, Lukask HC: Whole-body impedance – what does it measure? Am J Clin Nutr 1996;64(suppl 3):S388–S396.
29.
Lim S, Joung H, Chin CS, Lee HK, Kim KS, Shin EK, Kim HY, Lim MK, Cho SI: Body composition changes with age have gender-specific impacts on bone mineral density. Bone 2004;35:792–798.
30.
Chan TM, Pun KK, Cheng IK: Total and regional bone densities in dialysis patients. Nephrol Dial Transplant 1992;7:835–839.
31.
Johnson DW, McIntyre HD, Brown A, Freeman J, Rigby RJ: The role of DEXA bone densitometry in evaluating renal osteodystrophy in continuous ambulatory peritoneal dialysis patients. Perit Dial Int 1996;16:34–40.
32.
Woodrow G, Devine Y, Cullen M, Lindley E: Application of bioelectrical impedance to clinical assessment of body composition in peritoneal dialysis. Perit Dial Int 2007;27:496–502.
33.
Lee SW, Song JH, Kim GA, Lee KL, Kim MJ: Assessment of total body water for anthropometry-based equations using bioimpedance as reference in Korean adult controls and haemodialysis subjects. Nephrol Dial Transplant 2001;16:91–97.
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2011
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