Effect of Peritoneal Dialysate on Bioelectrical Impedance Analysis Variability in Pediatric Patients Receiving Peritoneal Dialysis

Abstract

Abstract Background: Previous adult studies have yielded conflicting results regarding whether the presence (D+) or absence (D-) of peritoneal dialysate affects the accuracy of bioelectrical impedance analysis (BIA) measurements. The aim of this study was to investigate whether the accuracy of BIA data varies between D+ and D- measurements in children. Methods: This cross-sectional study recruited chronic kidney disease stage 5 patients aged 3 to 18 years who received peritoneal dialysis. Body composition was assessed by multifrequency BIA, and values were compared between D+ and D- measurements using the intraclass correlation coefficient (ICC) and Bland-Altman plots. Results: Fifty paired BIA measurements were collected from 18 patients with a mean age of 13.6±4.1 years and a mean dialysate fill volume of 1,006±239.7 ml/m2. Almost all BIA parameters exhibited excellent correlations between D+ and D- measurements (ICC values=0.954-0.998). There was a trend of increased fluid status, including extracellular water, edema index, and overhydration, in D+ measurements, with mean differences (95% CIs) of 0.5 (0.4-0.6) L, 0.002 (0.001-0.002), and 0.1 (0.1-0.2) L, respectively. Soft lean mass and fat-free mass were higher in D+ measurements, with mean differences (95% CIs) of 1.4 (1.2-1.6), and 1.6 (1.4-1.8) kg, respectively. The Bland-Altman plots showed low variability in BIA parameters, as indicated by the narrow 95% limits of agreement between D+ and D- measurements. Conclusions: Almost all BIA parameters exhibited excellent correlations and low variability between D+ and D- measurements. We recommend that BIA measurements be collected from children regardless of the presence of peritoneal dialysate.