Body Water Distribution in Hemodialysis Patients at Moi Teaching and Referral Hospital

Background Patients undergoing hemodialysis require fluid balance management to prevent both under- and overhydration. This is because fluid imbalance has been associated with the development of both cardiovascular complications and intradialytic morbidity. The existing dry weight assessment is fraught with lots of inaccuracies, necessitating the use of bioimpedance analysis (BIA) as a more objective way of assessing body water distribution, determining dry weight, and nutritional status. Objective To determine the body water distribution among patients on hemodialysis at Moi Teaching and Referral Hospital. Methods This was a descriptive cross-sectional study conducted at the Moi Teaching and Referral Hospital in Eldoret, Kenya, among end-stage renal disease patients on hemodialysis. It included adults aged at least 18 years on regular maintenance hemodialysis for more than 3 months, who had achieved a clinically subjective dry weight. Those diagnosed with heart failure and neoplastic conditions, on regular steroids, with limb amputation, and metallic devices, like pacemakers and artificial joints, were excluded. The height and weight of each participant were taken before conducting the BIA procedure using the Body Composition Analysis (BCA) machine. All the results were entered into the Cyprus 2.7, a BCA software, to determine the body composition. Data was analyzed using STATA statistical software version 12, and descriptive statistics were presented as mean, median, and inter-quartile range. The mean difference was determined by using a student’s t-test. Results The 51 participants enrolled had a mean age of 47 years; 32 (63%) of whom were male. 28 (55%) attended 2 dialysis sessions weekly, while the rest had a single session. The average excess extracellular fluid (ECF) among all the participants was 1.5 liters (± 3.0), p = 0.005. 35 (69%) had excess ECF, averaging 3.0 liters (± 2.03). Malnutrition (Body Mass Index < 22kg/m ² and phase angle < 5) was seen in 42(82%) participants. There were no statistically significant differences in ECF, total body water, body mass index, body cellular mass, free fat mass, and phase angle between participants with a single or multiple dialysis sessions. Conclusion The clinical method underestimated the excess ECF, and this could predispose dialysis patients to complications associated with fluid imbalance. Most of the patients were also found to be malnourished. This study recommends incorporating BIA into the assessment of dry weight and nutrition.