Bioelectrical Impedance Measurements for Assessment of Kidney Function in Critically Ill Patients.

Abstract:

OBJECTIVES:To evaluate the use of multifrequency bioelectrical impedance analysis to predict creatinine/urea clearance based on 24 hours urine collection. A practical formula was developed, and its performance was compared with that of established formulas such as Cockcroft-Gault, Modification of Diet in Renal Disease, and Jelliffe's. DESIGN:An open-label prospective observational cohort study. SETTING:A 12-bed ICU at a nonuniversity major teaching hospital (Gelre ziekenhuizen Apeldoorn/Zutphen, The Netherlands). PATIENTS:Adult critical care patients with an expected ICU length of stay at admission of at least 48 hours. INTERVENTIONS:Each patient's body composition was assessed using a validated Quadscan 4000 analyzer (Bodystat, Isle of Man, British Isles). Twenty-four hours urine was collected, and laboratory variables in serum including creatinine, urea, and albumin were obtained at the beginning and end of the collection period. MEASUREMENTS AND MAIN RESULTS:A total of 151 patients, stratified to an acute and nonacute ICU-group, were enrolled in the study over a 2-year period. A formula to predict creatinine/urea clearance based on 24 hours urine collection was developed using stepwise linear regression using a training data set of 75 patients. This formula was subsequently tested and compared with other relevant predictive equations using a validation data set of 76 patients. Serum creatinine values ranged from 40 to 446 µmol/L. With the predictive model based on estimated body cell mass and a "prediction marker" more than 71% of the observed variance in creatinine/urea clearance based on 24 hours urine collection could be explained. Predictive performance was superior to the other eight evaluated models (R = 0.39-0.55) and demonstrated to be constant over the whole range of creatinine/urea clearance based on 24 hours urine collection values. CONCLUSIONS:Multifrequency bioelectrical impedance analysis measurements can be used to predict creatinine/urea clearance based on 24 hours urine collection with superior performance than currently established prediction models. This rapid, noninvasive method enables correction for influences of a patient's actual body composition and may prove valuable in daily clinical practice.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

de Jong LAA,Otten-Helmers AG,Spronk PE,van Kan HJM

doi

10.1097/CCM.0000000000004033

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

e984-e992

issue

12

eissn

0090-3493

issn

1530-0293

journal_volume

47

pub_type

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