Validation of the SMH Equations for the Estimation of the Total Body Water Volume in Hemodialysis Patients

Abstract

Background: Online dialysis clearance monitors typically provide an accurate value for Kt. A value for V (total body water [TBW]) is required to calculate Kt/V, the measure of the adequacy of the delivered dialysis in hemodialysis (HD) patients. Using bioimpedance spectroscopy (BIS), we previously developed 2 sex-specific equations for the estimation of the TBW, which we have chosen to name the St Michael’s Hospital (SMH) equations. Objective: The objective of this study was to validate the SMH equations in a second distinct population of patients. Design: Cross-sectional study. Setting: Single center hemodialysis unit at St Michael’s Hospital, a tertiary care teaching hospital, in Toronto, Canada. Patients: Eighty-one adult HD patients who had been receiving conventional maintenance HD for at least 3 months. Measurements: Anthropometric measurements including weight, height, and waist circumference were collected. TBW was measured by BIS using the Body Composition Monitor (Fresenius Medical Care, Bad Homburg, Germany). Methods: The Bland-Altman method to calculate the bias and limits of agreement and the difference plot analysis were used to evaluate the difference between the BIS-TBW and the TBW derived from our equations (SMH equation) in this validation cohort. Results: The TBW values based on our equations had a high correlation with BIS-TBW (correlation coefficients = 0.93, P values < .01, bias = 1.8 [95% CI: 1-2.6] liter). Application of SMH equations closely predicted Kt/V, based on BIS value, in all categories of waist circumference. Limitations: Small sample size, single-center, not including peritoneal dialysis patients. A larger and more heterogeneous sample with more patients at the extremes of body mass index would allow for more detailed sub-group analyses in different races and different anthropometric categories to better understand the performance of these equations in discrete sub-groups of patients. Conclusions: In maintenance HD patients, our previously derived equations to estimate the TBW using weight and waist circumference appear to be valid in a distinct patient population. Given the centrality of TBW to the calculation of small molecule clearance, the SMH equations may enhance the measurement of dialysis adequacy and inform practice.