DIAGNOSTIC ACCURACY OF BIOELECTRICAL IMPEDANCE ANALYSIS VERSUS DUAL-ENERGY X-RAY ABSORPTIOMETRY FOR BODY COMPOSITION ASSESSMENT IN CHILDREN WITH CKD STAGES 3–5 - International Society of Nephrology Events

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E-Poster

Abstract Title *

DIAGNOSTIC ACCURACY OF BIOELECTRICAL IMPEDANCE ANALYSIS VERSUS DUAL-ENERGY X-RAY ABSORPTIOMETRY FOR BODY COMPOSITION ASSESSMENT IN CHILDREN WITH CKD STAGES 3–5

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Presenter First Name

Madhu Sudhan

Presenter Surname

Karri

Co-author 1

Madhu Sudhan Karri madhusudhan5227@gmail.com Post Graduate Institute of Medical Education and Research Pediatrics chandigarh India *

Co-author 2

Lesa Dawman lesadawman@gmail.com Post Graduate Institute of Medical Education and Research Pediatrics chandigarh India -

Co-author 3

Jaivinder Yadav jai984yadav@gmail.com Post Graduate Institute of Medical Education and Research Pediatrics Chandigarh India -

Co-author 4

Harvinder Kaur harvinderkaur315@gmail.com Post Graduate Institute of Medical Education and Research Pediatrics Chandigarh India -

Co-author 5

Karalanglin Tiewosh ktiewosh@rediff Post Graduate Institute of Medical Education and Research Pediatrics Chandigarh India -

Co-author 6

Tulika Singh tulikardx@gmail.com Post Graduate Institute of Medical Education and Research Radiology Chandigarh India -

Co-author 7

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Co-author 8

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Co-author 9

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Co-author 10

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Co-author 11

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Co-author 12

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Co-author 13

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Co-author 14

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Co-author 15

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Introduction

Children with chronic kidney disease (CKD) frequently experience impaired growth, malnutrition, and bone health disturbances. Dual-energy X-ray absorptiometry (DXA) is the gold standard for assessing body composition; however, it is limited by its high cost and restricted availability. Bioelectrical impedance analysis (BIA) offers a simpler and more accessible alternative; however, its accuracy in pediatric patients with CKD remains uncertain. This study compared BIA with DXA in evaluating fat mass (FM), fat-free mass (FFM), and bone mineral parameters, and explored their associations with CKD stage, sex, and prevalence of low body fat and bone mineral density (BMD).

Methods

This cross-sectional study, conducted between January 2024 and June 2025, included 102 pre-dialysis children aged 4–14 years with CKD stages 3–5 who underwent same-day body composition assessment using BIA and DXA. Children on dialysis, those with limb amputation, electronic implants, acute infections, malignancy, HIV, fluid overload, or non-ambulatory status (including wheelchair users and inpatients) were excluded from the study. Body composition was measured using the BioScan Touch i8–Nano BIA device in the supine position after a 10-minute rest, following a tetrapolar wrist-to-ankle whole-body protocol. Total body BMD was assessed using a whole-body bone mineral densitometer DXA unit (Discovery A™, Hologic®), with participants positioned supine, hands pronated, feet inverted with toes touching, and the midsagittal plane aligned to the couch midline. Agreement between the methods was analyzed using Bland–Altman plots with limits of agreement (LOA). Linear regression was applied to evaluate proportional bias, and Lin’s concordance correlation coefficient (CCC) with 95% confidence intervals (CI) assessed overall agreement. Subgroup analyses were conducted according to CKD stage and sex.

Results

BIA correlated strongly with DXA for FM (r = 0.926), FFM (r = 0.915), and total bone mineral content (r = 0.841), with corresponding CCCs of 0.659, 0.874, and 0.806, respectively. Agreement for body fat percentage was weaker (CCC = 0.286; bias =–9.21%), and lumbar bone measurements showed poor concordance. BIA tends to underestimate FM and overestimate FFM. DXA detected stage-wise differences in FM, FMI, and FFM, which were less pronounced with BIA. Sex-specific differences were observed in BF% and FFMI. BIA slightly overestimated the prevalence of low BMD and body fat compared to that of DXA.

Conclusion

BIA correlated strongly with DXA for FM (r = 0.926), FFM (r = 0.915), and total bone mineral content (r = 0.841), with corresponding CCCs of 0.659, 0.874, and 0.806, respectively. Agreement for body fat percentage was weaker (CCC = 0.286; bias =–9.21%), and lumbar bone measurements showed poor concordance. BIA tends to underestimate FM and overestimate FFM. DXA detected stage-wise differences in FM, FMI, and FFM, which were less pronounced with BIA. Sex-specific differences were observed in BF% and FFMI. BIA slightly overestimated the prevalence of low BMD and body fat compared to that of DXA.

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