Bioimpedance analysis (extracellular mass to body cell mass ratio) as complementary assessment for malnutrition in hemodialysis patients

Background: Protein energy wasting (PEW) is a frequent condition in haemodialysis patients but often goes missed. The diagnosis of PEW is complex even though composite nutritional indices seem to show strong correlations with mortality and cardiovascular events. Bioimpedance analysis in dialysis centres is used to study patient's degree of water load but not to assess nutritional status. Recently, the extracellular mass/body cell mass ratio (ECM/BCM) ≥ 1.2 has also been considered as a parameter of malnutrition in the haemodialysis patients. Objective: To assess the nutritional reliability of ECM/BCM ≥ 1.2 in patients referred to the Dialysis Centre of the “S. Spirito Hospital” Rome. Methods: 16 Patients were enrolled and than evaluated anthropometrically, for nutritional and inflammatory parameters, subjected to the Malnutrition Inflammation Score (MIS) and monitored with impedance measurements before, after and 30 min after the haemodialysis session. Results: ECM/BCM ≥ 1.2 demonstrates a statistically significant direct correlation ( p < 0.001) with MIS. Albumin and pre-albumin were inversely correlated with ECM/BCM ≥ 1.2, cholesterolaemia was directly correlated. Conclusions: ECM/BCM ≥ 1.2 appears to be a simple and reliable indicator for the diagnosis of malnutrition in the chronic haemodialysis patient. Given the small sample size, further studies are needed to support this thesis.