When the kidney is not functioning properly, the capacity to excrete sodium and water decreases, resulting in edema and high blood pressure. Hemodialysis is the method of removing waste from blood to maintain a balance of electrolytes in the body and removing excess water by using a dialyzer (artificial kidney).
After a patient completes hemodialysis, the InBody may be used to check the extracellular water ratio (ECW/TBW) to ensure that the body water level has returned to a state of balance. Dialysis patients tend to show a significantly high ECW ratio when compared to a healthy person. This ratio drops significantly to a normal level after dialysis.
Shown below is a set of InBody tests that illustrate the changes in body water a patient undergoes with dialysis.
* Examples from the InBody770
The patient’s body water can be shown as balanced after the InBody Test results verify that the ECW ratio has dropped to a normal range after dialysis. If the ECW ratio remains high, even after dialysis, the InBody Test results can be used as a reference for resetting the dry weight, and adjusting the filtration amount.
Dry weight setting is still subjective to clinical judgments based on blood pressure, X-ray measurements, ultrasonic measurements, and etc. It requires a long series of trial and error because it tends to be inaccurate and often results in excess body water.
On the other hand, the InBody provides quantitative information about total body water, extracellular water, intracellular water, and the ECW ratio. It provides substantial assistance in determining the dry weight, the body weight in adequate body water balance after removal of excess extracellular water.
Dialysis facilities in Japan are currently using the ECW ratio from the InBody to determine dry weight for dialysis patients. A study published in 2007 evaluated the usefulness of the InBody’s body water measurement in body fluid assessment and whether it could be a determining indicator of dry weight. Correlation to body weight in normal ECW ratio—defined as BIA-DW—was examined against the clinical dry weight (cDW) based on CTR, hANP, IVC, etc. The BIA-DW and cDW showed a high level of correlation, implying that the dry weight determined by InBody was actually useful. (Journal of Japanese Society for Dialysis Therapy 40(7):581-588, 2007)
It has recently been reported that a higher ECW ratio of peritoneal dialysis and hemodialysis patients is related to residual renal function, inflammation, and malnutrition. This implies that body water balance monitoring of peritoneal dialysis patients is significant.
The InBody Test may also be useful for cirrhosis patients with failing liver function, whose their healthy liver tissues turn fibrotic due to chronic inflammation. Due to deteriorating liver function, cirrhosis patients may suffer from symptoms such as jaundice and hepatic encephalopathy. etc. In terms of body composition, the patients may suffer from ascites, the swelling of both legs due to body water retention.
While edema and ascites are common symptoms, the difficulty is in identifying them through visual examination. According to a report published in 2009 by Mie University in Japan, ECW ratio determined by InBody was higher for patients with severe cirrhosis and ascites conditions.
The higher the Child-Pugh grade, which indicates the level of liver failure, the higher the ECW ratio remained. The rate of ascites discovery increased dramatically for patients with ECW ratio of 0.398 and above. This study showed that the InBody can be used as an indicator for monitoring the ascites level and progress of hepatic disease. (Hepatology Research 2009)
Diabetes is a metabolic disease, that indicating insufficient insulin secretion or failure of insulin control. As of 2010, the prevalence rate for diabetes among Korean adults 30 years of age or older is 10.1%.
Blood glucose is used and stored in the muscles. A diabetic patient losing muscle mass is likely to have adverse effects on glycemic control. According to a University of California Los Angeles study of over 14,000 adult men and women, people with higher muscle to weight ratio had lower risk of diabetes (J Clin Entocrinol Metab, 2011). A 2010 study in Japan also showed that diabetic patients have less muscle mass, especially in the leg, than healthy individuals. (Metabolic Syndrome and Related Disorders, 2010)
As leg muscles decrease, insulin resistance and risk of cardiovascular disease increases. Monitoring leg muscle mass is usually conducted by taking images of the thigh muscle area with computed tomography (CT). While CT scans may expose patients to radiation, the InBody provides quantitative values of muscle mass in a much safer and convenient way.
Diabetic patients tend to suffer from renal function deterioration in addition to difficulty in excretion of body water and waste. Many diabetic patients require dialysis when the condition becomes serious. According to a paper published in 2012 by Royal Free Hospital in Britain, peritoneal dialysis patients suffering from diabetes had significantly higher ECW ratio than patients without diabetes (Nephron Clinical Practice, 2010).
Shown below are body composition analysis results of a diabetic patient. The leg muscle mass is below 80%, while the ECW ratio exceeds the standard range at 0.404. The patient and the physician are in fact considering dialysis due to the deteriorating renal function.
As seen above, the InBody is useful in monitoring muscle mass, especially in the legs, to maintain healthy glycemic control and to detect increases in ECW ratio, which could be due to deteriorating renal function.
Quantitative nutritional assessment is crucial as malnutrition is known to increase the risk of complications and mortality in patients. The InBody allows the monitoring of quantitative changes in body composition against body weight during patient recovery.
Kyoto University, in Japan, has published numerous research papers on nutritional assessment of liver transplant patients. Analysis of the InBody results, accumulated over numerous years, reveals that liver transplant patients with low body cell mass (BCM) before surgery had significantly higher ward mortality rate than patients with normal or high BCM, due to sepsis and infection. This indicates the significance of BCM monitoring (Nutrition, 2012).
Chang Gung Memorial Hospital, in Taiwan, published study results from the InBody ECW ratio measurements of patients with heart diseases. In this 6-month study, events such as re-hospitalization, recurrence or mortality of patients, and admitted for operation on acute heart failure and discharged, were significantly lower in patients who had the ECW ratio monitored throughout the treatment(International Heart Journal, 2012).
Muscle mass data, provided by InBody, can be used for a wide range of applications. Fitness clubs, for example, can monitor changes in body fat and muscle. The effects of aerobic and strength exercises can be verified through objective data. Such segmental muscle mass data is also highly useful in orthopedics and rehabilitation therapy.
Patients with short, lower graphs in leg muscle mass are likely to suffer from orthopedic diseases because their knees and ankles are subject to exceptionally heavy loads. In fact, there are studies showing that patients with knee osteoarthritis have weak leg muscles, compared to their body weight (J Clin Rheumatol 2005).
Indicated below are the InBody test results of a patient with arthritis in the right knee. Although the overall muscle mass is within the normal range the patient’s leg muscle mass is below the normal range, unlike the patient’s arms and trunk.
Therefore, it is significant to use the InBody Test to monitor the segmental muscle mass in addition to rehabilitation therapy.