Bioelectrical impedance vs air displacement plethysmography and dual-energy X-ray absorptiometry to determine body composition in patients with end-stage renal disease

BACKGROUND: Patients with end-stage renal disease (ESRD) have significant shifts in fluid homeostasis that may impair measurements of body composition using methods based upon determinations of body water. Estimates of body water are fundamental for bioelectrical impedance analysis (BIA), which measures electrical resistance to estimate total body water and body composition. METHODS: BIA was compared with 2 other techniques: (1) air displacement plethysmography (ADP), which relies on measurements of body density to estimate body fat and fat-free masses; and (2) dual-energy x-ray absorptiometry (DXA), which depends on the relative attenuation of an x-ray beam to produce images of body fat and bone mineral. In study 1, BIA and ADP were performed on 38 ESRD patients (21 men and 17 women; age 51.3 +/- 2.2 years; weight 79.8 +/- 2.9 kg; body mass index [BMI] 27.4 +/- 0.9 kg/m2). In study 2, BIA and DXA were performed on 47 patients (22 men and 25 women; age 52.7 +/- 2.3 years; weight 73.6 +/- 2.9 kg; BMI 25.9 +/- 1.0 kg/m2). RESULTS: The ranges of percent body fat using BIA in studies 1 and 2 were from 7% to 57% and from 6% to 52%, respectively. Percent body fat measurements were significantly (p < .0001) correlated for BIA vs ADP (r = .74) and for BIA vs DXA (r = .84). Mean body fat as determined by BIA and ADP in study 1 was 31.8 +/- 2.0% and 36.3 +/- 1.8%* and by BIA and DXA in study 2 was 29.6 +/- 1.5% and 31.8 +/- 1.8%*, respectively (*p < .05 vs BIA). All 3 methods had similar variability associated with their measurements (coefficients of variation approximately 5%). The average body fat measured by BIA was less than ADP or DXA, regardless of gender or race. Furthermore, the variation was not greater at lower or higher body fat values. CONCLUSIONS: Body fat measurements using ADP and DXA were correlated with those using BIA across a relatively wide range of body fat levels in adults with ESRD. However, BIA appeared to underestimate body fat and overestimate fat-free mass, possibly because of increased measurements of body water. Because ADP is convenient and does not use body water content in determination of body density and body composition, it has very good potential as a relatively new technique to estimate percent body fat in adults with ESRD.