Agreement between vector analysis and body composition measurements by four types of bioelectrical impedance technology in hemodialysis patients

Abstract

Background: the differences in bioelectrical impedance vector analysis (BIVA) results from different analyzers that use different bioelectrical impedance analysis (BIA) measurement technologies are not known. This study aimed to identify the degree of agreement between the BIVA results of four different BIA measurement techniques and to evaluate the degree of agreement between their estimates of fat-free mass (FFM) and fat mass (FM) and those determined by the gold-standard method of dual-energy X-ray absorptiometry (DEXA) in a subgroup of patients without overhydration. Methods: a cross-sectional study was conducted with hemodialysis (HD) patients with end-stage renal disease (ESRD) aged 18 to 65 years. BIA was measured with four different techniques: spectroscopic (BIA-BIS), multifrequency (BIA-MF), single-frequency (BIA-SF), and segmental multifrequency (BIA-MS) techniques. The differences and concordance between the components of the BIA (resistance, reactance, and phase angle) of the four devices were analyzed. Patients with a normal hydration status were identified, and concordance between FM and FFM measurements with each impedance device and DEXA was observed only in these patients. Results: thirty patients were included. The concordance between the components of BIA ranged from good to excellent (phase angle: intraclass correlation coefficient (ICC) = 0.82, 95 % confidence interval (CI): 0.77-0.93; resistance: ICC = 0.98, 95 % CI: 0.92-0.99). The overall concordance for BIVA diagnosis between the analyzers was substantial for hydration (k = 0.71, 95 % CI: 0.71-0.72) and for body tissues (k = 0.68, 95 % CI: 0.67-0.68). Bland–Altman plots showed the lowest bias between BIA-BIS and DEXA for both FM and FFM. Conclusions: the agreement among the four devices was good for diagnosis by BIVA. The BIA-BIS analyzer and DEXA had the lowest bias for both FFM and FM, although with higher limits of agreement. The lowest limits of agreement were found with the BIA-MS analyzer.