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Bioimpedance Analysis and Assessment of Intracellular Water in Peritoneal Dialysis Patients

Bioimpedance analysis (BIA) techniques are widely used to assess body composition in dialysis patients. However, some questions remain with respect to the use of BIA in the nutritional assessment of dialysis patients. First, it is not well known whether multifrequency BIA (MF-BIA) measurement techniques have any advantage over single-frequency (SF-BIA) measurements in the assessment of intracellular water (ICW), which reflects body cell mass (1). With SF-BIA, ICW is estimated from regression analysis, taking into account resistance (R) (the in-phase opposition of the conductor to current) and reactance (Xc) (the additional opposition due to the capacitance of cell membranes) at a single frequency (2). MF-BIA distinguishes between extracellular (ECW) and ICW volume because, at low frequencies, the cell membrane acts as a capacitor and blocks the flow of current through the cell; whereas, at higher frequencies, current flows through both the intraand the extracellular space (3). Second, a parameter that has been widely used as a nutritional and even as a prognostic parameter is phase angle, which is the arctangent of the Xc/R ratio (1). From a theoretical point of view, phase angle may be reduced either by a reduction in body cell mass or an increase in ECW (1). Although some studies have shown a relation between phase angle and ECW in dialysis patients (4), the relation between phase angle and ICW has not yet been studied in dialysis patients. The aims of the present study were, first, to compare MF-BIA and SF-BIA in the assessment of ICW and, second, to estimate the relationship between phase angle and body compartments in peritoneal dialysis patients.