Using the right dialysis settings with seca mBCA

- Millions of people worldwide suffer from chronic renal disease, with currently 2.5 million people dependent on regular dialysis treatment due to terminal renal failure. If a donor organ isn’t available at this critical stage or a transplant is contraindicated, dialysis is the only remaining option for effective treatment. While it can be a short-term solution, dialysis can also replace the kidneys’ functions over a long period of time. By using hemodialysis, the blood is cleansed outside the body using a special filter called a dialyzer, before it is reintroduced into the body again. This method is used to regulate hydration and electrolyte balance, as well as to eliminate metabolic (by-)products and toxins.

Physiologically, the kidneys take on a variety of different tasks, such as the regulation of the electrolyte and water balance, as well as hormone production. The electrolyte concentration requires close regulation, since even the smallest changes can lead to serious consequences, such as cardiac arrhythmia. In order for patients to maintain their quality of life and to improve their long-term prognosis, the dialysis settings have to be monitored regularly, especially for the patient’s state of hydration, as well as the toxins and electrolytes within their blood. Often, a patient’s weight is used as a measuring unit for their state of hydration, despite the fact that as a sole value, it is very imprecise. Weight can not yield reliable information on water balance because weight is also influenced by changes in fat or muscle mass. While small shifts in fluids may indicate an inadequate dialysis calibration; measuring them accurately by means of weight is very difficult.

Our seca mBCA offers a much more precise method for analyzing a patient’s body composition. By means of bioimpedance analysis, seca mBCA takes into account the fat mass and muscle proportions as well as the total body fluid and measures them precisely. In addition, seca mBCA can detect fluid shifts within the body and therefore helps to optimize the dialysis process.

To illustrate the practical use of the seca mBCA in dialysis patients, consider the following clinical example:

For her chronic renal insufficiency, a 62-year-old patient has been undergoing regular dialysis treatment for the past eight years. Before each treatment session the patient weighs in at 87.55 kg, and after the session her weight is reduced to 86.2 kg. The dialysis has therefore filtered 1.3 liters of excess water. However, the patient’s weight is not an accurate statement of her actual hydration state after the session and an overhydration cannot be ruled out. The seca mBCA can help with an accurate evaluation of the hydration state. Analyzing the patient’s body composition demonstrates that the dialysis decreased her extracellular water from 18.7 liters to 17.4 liters. This value corresponds to the measured change in weight.

In order to exclude the possibility of excess water remaining within the body after the dialysis, a bioelectric impedance vector analysis (BIVA) can be performed using seca mBCA. The results provide accurate information about the condition of the cells and the hydration state of the patient’s body.

In our example, the initial measurement that takes place before the dialysis puts the BIVA-vector in the range of the white 95 percentile, indicating a distinct increase in the extracellular water volume. However, the second measurement (2) after the dialysis shows that the BIVA-vector has shifted to the green normal range and the hydration state has normalized - proving that the patient’s dialysis settings are well adjusted. By using seca mBCA, the dialysis settings can be precisely monitored and, if necessary, adjusted at an early stage to avoid serious complications within the patient.

Image 1 © “sudok1” / Fotolia.com

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