Fresenius Medical Care The BCM – Body Composition Monitor allows the detection of overhydration by determining the quantitative amount of excess fluid in. Fresenius Medical Care SUPPORT. For further information on the BCM – Body Composition Monitor, please see the following downloads: General Information. Download scientific diagram | The Fresenius’ Body Composition Monitor (BCM) is an example of multi-frequency Bio-impedance analysis technology. Picture.
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This gave the possibility of making BCM measurements across a number of paths and also allowed the isolation of individual segments for measurement see figure 1. Yet there is a lack of data to support use of BCM outside this standardised approach and there remains a great deal of uncertainty in utilisation of the technology in certain individuals. To present the data, results for a 60 year old female measured on the standard path acted as a reference standard path was taken as hand-to-foot on the dominant side of the body for controls and on and the contralateral side of the body to the most recently used vascular access VA for dialysis patients.
In principle the models that were generated and validated for the standard path can be employed with alternate paths. Bioimpedance-guided fluid management in maintenance hemodialysis: Current opinion in clinical nutrition and metabolic care. Calf bioimpedance spectroscopy for determination of dry weight in hemodialysis patients: Significance levels were set at 0.
Segmental bioelectrical impedance analysis. There are also a number of situations where it would be helpful to make post-dialysis BCM measurements. The results here confirm that the presence of a vascular access does tend to increase OH.
Measurements should also be made from hand-to-foot — as this is the only validated measurement path — and should avoid peripheral access sites, due to the presence of anatomical changes. The American journal of clinical nutrition. Statistical analysis To investigate the validity of post-dialysis measurements, the agreement between change in BCM-measured OH from the reference path and change in weight was assessed using Bland-Altman analysis.
Data are presented for a 60 year old female, where the adjustment for OH with age was Table 2 Model for OH in healthy controls. Methods Subjects Ethical approval was granted by a local ethics committee and all participants provided informed consent.
Body composition monitor Files
The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. Furthermore, the consistency of LTM and ATM from the start to end of dialysis was assessed based on the effect of measurement time in each of the mixed-effects models.
However, in practice these requirements would exclude a relatively large number of patients from having BCM measurements. Fresenius Medical Care; The study was not powered to address the multiple comparisons made by the models – the sample size was based on comparisons between the two primary whole-body paths only.
Body Composition Monitor
The 8-lead device does not display Cole-plots or body composition data to allow real-time assessment of artefacts or consistency, so repeat measurements were not made. Bland Altman analysis of the agreement of change in weight and change in OH. The use of measurement time as an freseniuss term in the models for dialysis patients showed that measured-OH changed by a different amount between the paths. Routine target weights were defined on the basis of clinical examination and BCM on indication.
Use of alternate paths The data from healthy controls show that there is no difference in BCM-measured OH between all the whole-body paths other than the foot-to-foot measurement, which had a difference of 0. The potential for the equivalence of impedance across different paths was demonstrated two decades ago using bioimpedance analysis BIA measurements Lukaski et al.
Where accurate monitoring of body composition is important, the standard pathway is preferred and consistency is important. However, neither BIA or SBIA can adequately distinguish excess fluid from bm and adipose tissue, which left the possibility that the differences observed relate to differences in lean tissue alone rather than excess fluid, particularly given that fistulae tend to freseniux placed in the non-dominant arm of patients.
Making BCM measurements post-dialysis introduces a negligible bias to OH measurements but does increase measurement uncertainty, which should be accounted for when interpreting such data. A larger sample would allow better estimates of these different estimates. The effect of vascular access modality on changes in fluid content in the arms as determined by multifrequency bioimpedance. This is based on a number of key observations: American journal of kidney diseases: The use of mixed-effects regression allowed a model to be built that could account for the repeated measures on an individual from the 8-lead BCM.
One of the implications of preferential removal of fluid from the legs than arms could be that the legs are the last segment that fluid is recruited from. Journal of Applied Physiology.
The only statistically significant bcmm was for the foot-to-foot path, which suggests that there is a greater change in BCM-measured OH across this path compared to the other paths. Measurements over the first 75 minutes of dialysis using BIS Shulman et al. Ethical approval was granted by a local ethics committee and all participants provided informed consent.
Considering the use of post-dialysis BCM measurements, change in body weight was compared to change in BCM-measured OH as there is no accepted gold standard measure of OH to validate post-dialysis measurements.
Data collection Healthy controls had height measured using a stadiometer and weight measured using calibrated scales. Any of the whole body paths other than foot-to-foot can be used as an alternative to the standard path for freseniud of OH, with an acknowledgement of the additional uncertainty when interpreting the results. Fluid shifts from the limbs into the trunk manifest as an apparent decrease in ECF when measured by whole-body techniques and shifts from the trunk to the limbs as an increase in ECF Lundvall et al.
This characterises the individual differences in fluid status and body composition and accounts for this when describing the differences between the paths at the cohort level.
Supplementary Material Appendices Click here to view. However, there are few pragmatic studies that can help to inform the use of BCM outside of the strict protocol recommended for measurements and used bvm interventional studies, which can exclude a significant number of patients when BCM is used as part of routine care.
BCM measurements were made in 48 healthy controls and in 48 stable haemodialysis patients before and immediately after dialysis. The only investigation to consider alternative paths with BIS measurements was in preliminary work for this study, where it was shown that BCM-measured overhydration OH from the hand-to-hand fredenius is an acceptable alternative to the standard path Keane and Lindley, fressnius This uncertainty will be reduced with time after dialysis, such as asking patients to move off the dialysis station to be weighed, before a measurement is made.
This is related to the effect that ultrafiltration Abbas et al. Study limitations The study was not powered to address the multiple comparisons made by the models – the sample size was based on comparisons between the two primary whole-body paths only.
Accuracy of an eight-point tactile-electrode impedance method in the assessment of total body water. Changing from a whole-body measurement to a hand-to-hand or cross measurement will involve substitution of one limb for another and a change in the pathway through the trunk. There are reasonably large limits of agreement which should be taken into account when making post-dialysis measurements, but these measurements were taken immediately after dialysis and it is reasonable to assume that they would be reduced if there was a time delay introduced between dialysis end and BCM measurement, as recommended by the manufacturer.