Quantification of excretory renal function and urinary protein excretion by determination of body cell mass using bioimpedance analysisReportar como inadecuado

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BMC Nephrology

, 16:174

First Online: 27 October 2015Received: 19 April 2015Accepted: 19 October 2015


BackgroundCreatinine clearance CrCl based on 24 h urine collection is an established method to determine glomerular filtration rate GFR. However, its measurement is cumbersome and the results are frequently inaccurate. The aim of this study was to develop an alternative method to predict CrCl and urinary protein excretion based on plasma creatinine and the quantification of muscle mass through bioimpedance analysis BIA.

MethodsIn 91 individuals with normal and impaired renal function CrCl was measured from 24 h urine excretion and plasma creatinine concentration. A model to predict 24 h-creatininuria was developed from various measurements assessing muscle mass such as body cell mass BCM and fat free mass FFM obtained by BIA, skinfold caliper and other techniques training group, N = 60. Multivariate regression analysis was performed to predict 24 h-creatininuria and to calculate CrCl. A validation group N = 31 served to compare predicted and measured CrCl.

ResultsOverall accuracy, bias, precision, correlation the new BIA based prediction model performed substantially better compared with measured CrCl P15 = 87 %, bias = 0, IQR of differences = 7.9 mL-min-1.73 m, R = 0.972 versus established estimation formulas such as the 4vMDRD P15 = 26 %, bias = -8.3 mL-min-1.73 m, IQR = 13.7 mL-min-1.73 m, R = 0.935, CKD-EPI P15 = 29 %, bias = -7.0 mL-min-1.73 m, IQR = 12.1 mL-min-1.73 m, R = 0.932, Cockcroft-Gault equations P15 = 55 %, bias = -4.4 mL-min-1.73 m, IQR = 9.0 mL-min-1.73 m, R = 0.920. The superiority of the new method over established prediction formulas was most obvious in a subgroup of individuals with BMI > 30 kg-m and in a subgroup with CrCl > 60 mL-min-1.73 m. Moreover, 24 h urinary protein excretion could be estimated accurately by normalization with 24 h-creatininuria derived from BIA based BCM.

ConclusionPrediction of CrCl based on estimated urinary creatinine excretion determined from measurement of BCM by BIA technique is both accurate and convenient to quantify renal function in normal and diseased states. This new method may become particularly helpful for the evaluation of patients with borderline renal insufficiency and-or with abnormal body composition.

KeywordsBioimpedance analysis Body cell mass Creatinine clearance Glomerular filtration rate 24 h urine collection AbbreviationsGFRGlomerular filtration rate

eGFREstimated GFR

CrClCreatinine clearance

24hU-CrClMeasured CrCl based on a 24-hour urine collection

PCrPlasma creatinine

CKD-EPIChronic kidney disease epidemiology collaboration

4vMDRD4 variables modification of diet in renal disease

CGCockcroft-Gault formula

CG-CrClCreatinine clearance estimation by Cockcroft-Gault formula

24hU-Cr24 h creatininuria

m24hU-CrModel based 24 h creatininuria

mCrClmodel based creatinine clearance

UPCRUrinary protein creatinine ratio

24h-PU24 h urinary protein excretion 24 h proteinuria

pPUPredicted 24 h urinary protein excretion resp. proteinuria

BMIBody mass index

BSABody surface area

BIABioimpedance analysis

LBMLean body mass

FFMFat-free mass

BCMBody cell mass

ECMExtracellular mass

TSFTriceps skin fold

MACMidarm circumference

MAMCMidarm muscle circumference

DXADual x-ray absorptiometry

SEEStandard error of estimate

RCorrelation coefficient

SDStandard deviation

IQRInterquartile range

P25P75, 25, 75 percentile quartiles

P15Range of 15 % difference

P30Range of 30 % difference

LoALimits of agreement mean difference ± 1.96 of SD

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Autor: Stefan Flury - Johannes Trachsler - Albin Schwarz - Patrice M. Ambühl

Fuente: https://link.springer.com/

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