Comparison of bioimpedance versus pulse contour analysis for intraoperative cardiac index monitoring in patients undergoing kidney transplantation

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Background: Cardiac index (CI; cardiac output indexed to body surface area) is routinely measured during kidney transplant surgery. Bioimpedance cardiometry is a transthoracic impedance as the non-invasive alternative for hemodynamic monitoring, using semi-invasive uncalibrated pulse wave or contour (UPC) analysis. Objectives: We performed a cross-sectional observational study on 50 kidney transplant patients to compare the CI measurement agreement, concordance rate, and trending ability between bioimpedance and UPC analysis. Methods: For each patient, CI was measured by bioimpedance analysis (ICON™) and UPC analysis (EV1000™) devices at three time points: after induction, during incision, and at reperfusion. The device measurement accuracy was assessed by the bias value, limit of agreement (LoA), and percentage error (PE) using Bland-Altman analyses. Trending ability was assessed by angular bias and polar concordance through four-quadrant and polar plot analyses. Results: From each time point and pooled measurement, the correlation coefficients were 0.267, 0.327, 0.321, and 0.348. BlandAltman analyses showed mean bias values of 1.18, 1.06, 1.48, and 1.30, LoA of-1.35 to 3.72,-1.39 to 3.51,-1.07 to 4.04, and-1.17 to 3.78, and PE of 82.21, 78.50, 68.74, and 74.58%, respectively. Polar plot analyses revealed angular bias values of-10.37º,-15.01º,-18.68º, and-12.62º, with radial LoA of 89.79º, 85.86º, 83.38º, and 87.82º, respectively. The four-quadrant plot concordance rates were 70.77, 67.35, 65.90, and 69.79%. These analyses showed poor agreement, weak concordance, and low trending ability of bioimpedance cardiometry to UPC analysis. Conclusions: Bioimpedance and UPC analysis for CI measurements were not interchangeable in patients undergoing kidney transplant surgery. Cardiac index monitoring using bioimpedance cardiometry during kidney transplantation should be interpreted cautiously because it showed poor reliability due to low accuracy, precision, and trending ability for CI measurement.

Original languageEnglish
Article numbere117918
JournalAnesthesiology and Pain Medicine
Issue number5
Publication statusPublished - Oct 2021


  • Cardiac Output
  • Intraoperative Monitoring
  • Kidney Transplantation
  • Pulse Wave Analysis
  • Transthoracic Impedance


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