Evaluation of Hydration Status in Patients with Intestinal Insufficiency or Intestinal Failure by Bioelectrical Impedance Measurements
Author
Dyhre-Petersen, Nanna
Term
4. term
Publication year
2020
Submitted on
2020-05-29
Pages
51
Abstract
Vand er afgørende for kroppens funktioner. Mangel på vand (dehydrering) og for meget vand (overhydrering) kan begge forstyrre kroppen. Personer med intestinal insufficiens (INS) eller intestinalt svigt (IF) har ofte nedsat tarmfunktion og kan derfor have svært ved at holde en normal væskebalance. Nogle ernæres gennem munden (oral ernæring, ON), mens andre får ernæring direkte i blodet i hjemmet (hjemmeparenteral ernæring, HPN). For disse patienter er det vigtigt at vurdere væskestatus korrekt, men der findes ingen entydig “guldstandard”. I klinikken bruges både ældre mål som beregnet plasma-osmolaritet (hvor koncentreret blodet er) og 24-timers urinmængde, og nyere metoder som bioelektrisk impedansanalyse (BIA) og bioelektrisk impedans-vektoranalyse (BIVA), der måler, hvordan en svag elektrisk strøm bevæger sig gennem kroppen for at sige noget om væskeindhold. Formålet var at undersøge, hvor godt BIA og BIVA klarer sig som metoder til at vurdere væskestatus hos INS- og IF-patienter sammenlignet med beregnet plasma-osmolaritet og 24-timers urinmængde. Vi vurderede væskestatus hos 253 metabolisk stabile patienter med INS (n=125) eller IF (n=128). Hver patient blev inddelt som dehydreret, normalt hydreret (euhydreret) eller overhydreret ud fra hver af de fire metoder. Vi så på, om metoderne fulgtes ad, og om klassifikationerne var ens hos patienter på ON versus HPN. Resultaterne viste kun svage sammenhænge mellem plasma-osmolaritet og BIA/BIVA (korrelationskoefficient −0,150 til −0,245). Klassifikationen af væskestatus varierede markant mellem metoderne. Plasma-osmolaritet og 24-timers urinmængde gav en samlet forskel mellem ON- og HPN-patienter, men det kunne ikke fastslås, hvilken af de tre væskestatus-kategorier forskellen skyldtes. De nyere metoder kunne ikke skelne mellem ON og HPN på baggrund af væskestatus. Aftalen mellem metoderne var generelt lav; for parrene plasma-osmolaritet vs. BIA og plasma-osmolaritet vs. BIVA var den statistisk signifikant, men endda lavere end forventet ved tilfældighed (negativ vægtet kappa). Konklusionen er, at vurderingen af væskestatus hos INS- og IF-patienter afhænger af, hvilken metode man bruger, og at der ikke var reel overensstemmelse mellem de etablerede metoder (plasma-osmolaritet og 24-timers urin) og de nye (BIA og BIVA). Det var heller ikke muligt at sige, om ON-patienter oftere blev klassificeret som dehydrerede, euhydrerede eller overhydrerede end HPN-patienter. Der er behov for videre studier med bedre design for at afklare, hvilke metoder der faktisk virker bedst i denne patientgruppe.
Water is essential for the body. Too little (dehydration) or too much (overhydration) can disrupt normal functions. People with intestinal insufficiency (INS) or intestinal failure (IF) often have impaired gut function and are at risk of abnormal fluid balance. Some are fed by mouth (oral nutrition, ON), while others receive nutrition into the bloodstream at home (home parenteral nutrition, HPN). Accurately assessing hydration in these patients is important, but there is no single gold standard. Clinicians use older measures such as calculated plasma osmolarity (how concentrated the blood is) and 24-hour urine volume, and newer techniques such as bioelectrical impedance analysis (BIA) and bioelectrical impedance vector analysis (BIVA), which estimate body fluid by tracking a small electrical current through the body. This study evaluated how well BIA and BIVA assess hydration in INS and IF patients, compared with calculated plasma osmolarity and 24-hour urine volume. We assessed hydration in 253 metabolically stable patients with INS (n=125) or IF (n=128). Each patient was classified as dehydrated, euhydrated (normally hydrated), or overhydrated by each of the four methods. We examined whether the methods agreed with each other and whether they distinguished between patients on ON and HPN. Only weak correlations were found between plasma osmolarity and BIA/BIVA (correlation coefficients −0.150 to −0.245). Hydration classification varied widely by method. Plasma osmolarity and 24-hour urine volume suggested an overall difference between ON and HPN groups, but follow-up testing could not identify which hydration category explained the difference. The newer techniques did not distinguish ON from HPN based on hydration status. Agreement between methods was generally poor; for plasma osmolarity vs BIA and plasma osmolarity vs BIVA it was statistically significant yet even lower than expected by chance (negative weighted kappa). In conclusion, hydration status in INS and IF patients depended on the assessment method used, and there was no agreement beyond chance between the standard methods (plasma osmolarity and 24-hour urine) and the newer methods (BIA and BIVA). It was also not possible to conclude whether ON patients were more or less often classified as dehydrated, euhydrated, or overhydrated than HPN patients. Further, better-designed studies are needed to confirm these findings.
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