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ND
D
ND
D
20
ac
20
Women
30
Bl
ac
k
Men
30
te
Bl
Xc/H, ohm/m
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10
hi
10
ND
ND
D
te
hi
0
0
Fig. 1. Mean impedance vectors, standardized by height [resistance/height (R/H), reactance/height (Xc/H) (ohm/m) with 95%
confidence ellipses, by gender, race, or ethnicity, and diabetes status.
Separate 95% confidence ellipses indicate a significant (P < 0.05) vector displacement on the R-Xc plane. Abbreviations are: D, diabetic;
ND, nondiabetic.
RESULTS
The mean age was 60.5 15.4 years, 47.2% were
women, 46.9% black, 45.4% white, 6.5% Hispanic, and
1.2% of other races or ethnicities. Thirty-seven percent of
patients had diabetes mellitus. The median dialysis vintage was 2.6 years (interquartile range 1.4 to 4.9 years).
A detailed description of the distributions of R, Xc, and
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3
Men
50
30
95%
75%
50%
40
30
10
0
0 100 200 300 400 500
R/H, ohm/m
B
Men
0
0
40
m/
10
oh
10
50%
75%
95%
30
20
H,
20
.80
R/
30
.93
4.8
95%
75%
50%
20
30
40
Women
1.54
.98
40
Xc/H, ohm/m
50
95%
75%
50%
/H
0
10
50
0 0
Xc
m/
40
10
h
,o
20
20
10
20
2.83
2
50
95%
75%
50%
Women
30
Xc/H, ohm/m
40
Relative risk
50
0
0 100 200 300 400 500
R/H, ohm/m
50
dently associated with mortality. The association of vector length with mortality tended to be more pronounced
among men (vector length gender interaction, P =
0.07). Figure 3 shows the multivariable adjusted RR of
death within the six predefined vector length categories
plotted on the 50%, 75%, and 95% tolerance ellipses.
DISCUSSION
Inadequate fluid removal during hemodialysis can lead
to hypertension, heart failure, and stroke, among the
leading causes of death in dialysis patients. In contrast,
excessive fluid removal can lead to hypotension, arrhythmias, muscle cramping, nausea, vomiting, and other
adverse effects. Commonly, the rate of ultrafiltration exceeds the rate of vascular refill (especially with shorter
dialysis sessions), leading to inadequate intradialytic fluid
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CONCLUSION
In a large, nationally representative sample of
hemodialysis patients, we demonstrated a significant association between vector length (a known proxy for
volume status and ultrafiltration) and mortality. These
findings were independent of case mix, confounding laboratory values, and phase angle. These findings validate
the clinical observation linking longevity to maintenance
of dry body weight. Since hemodialysis population norms
of vector distribution, including length and phase angle, have been developed, bioelectrical impedance vector
analysis may be used to evaluate the adequacy of ultrafiltration in hemodialysis. Prospective, serial determinations of phase angle and vector length will be required to
determine the utility of bioelectrical impedance vector
analysis in clinical practice.
Reprint requests to Luana Pillon, M.D., New York University School
of Medicine, Old Bellevue 677, 550 First Avenue, New York, NY 10016.
E-mail: luana.pillon@med.nyu.edu
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