IEEE SENSORS JOURNAL, VOL. 20, NO.

13, JULY 1, 2020 7347

Monitoring Water Content of Blood During

Hemodialysis Based on Complex
Permittivity Measurement
Jingjing Shi , Member, IEEE, Shinnosuke Seo, and Jianqing Wang , Senior Member, IEEE

Abstract —In hemodialysis treatment, it is necessary to

accurately grasp the amount of waste products and the
amounts of water in the blood. Real time monitoring of the
water content of blood is effective for setting an appropriate
dialysis time and thus reduce the burden on hemodialysis
patients. In this study, we proposed a monitoring method of
water content of blood based on Lichtenecker’s exponential
law for complex permittivity expression and measurement
using a network analyzer and an open-ended coaxial probe.
The Lichtenecker’s exponential law expression in relation to
the water content is a new attempt. To verify its validity,
we first applied this method to apple juice with varying water
content and aqueous solutions of glucose. The estimated
water contents showed a relative error within 9% of actual ones, which ensured the validity of the proposed method.
Then we applied this method to monitor the water content of blood during dialysis for 18 hemodialysis patients. The
results showed a clear decrease of water content by dialysis for all hemodialysis patients. After dialysis, the estimated
water contents of the blood were all between 35% and 45%, essentially falling in the normal range of water content of blood,
nearly half. In addition, we also investigated the relationship between the water content and hematocrit in the blood, and
found a strong correlation coefficient of -0.8 between them. The results demonstrated the feasibility to monitor the water
content of blood during dialysis as well as hematocrit or anemia state based on the complex permittivity measurement.
Index Terms — Microwave measurement, complex permittivity measurement, hemodialysis monitoring, water content
of blood.

I. I NTRODUCTION amount of waste products such as blood urea nitrogen and

I N ORDER to realize a sustainable development society, it is
necessary to maintain the health of the elderly and improve
the quality of life of patients. Real time monitoring technol-
ogy for health information is therefore desirable [1]–[3]. For
example, hemodialysis is a medical practice which removes
metabolic waste from the blood and adjusts the amount of
water in place of the kidneys of patients with renal failure [4].
In dialysis treatment, it is necessary to accurately grasp the
Manuscript received January 14, 2020; accepted February 26, 2020.
Date of publication March 4, 2020; date of current version June 4, 2020.
This work was supported in part by the National Nature Science Foun-
dation of China under Grant 61701096, and in part by the Fundamental
Research Funds for the Central Universities under Grant N171904010.
The associate editor coordinating the review of this article and approving
it for publication was Dr. Qammer H. Abbasi. (Corresponding author:
Jianqing Wang.)
Jingjing Shi is with the Biomedical and Information Engineering
School, Northeastern University, Shenyang 110169, China (e-mail:
shijj@bmie.neu.edu.cn).
Shinnosuke Seo and Jianqing Wang are with the Graduate School of
Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan
(e-mail: wang@nitech.ac.jp).
Digital Object Identifier 10.1109/JSEN.2020.2978220
creatinine, as well as the amounts of water in the blood.
In usual case, however, blood components are analyzed in
batch processing, and the hemodialysis status is not monitored
during the dialysis [5]. If the hemodialysis status is easily
evaluated in real time, it is possible to set an appropriate
dialysis time and thus reduce the burden on hemodialysis
patients.
Complex permittivity is one of typical electrical properties
of biological tissue [6], [7]. When an electric field is applied
to a biological tissue such as the blood from the outside,
positive and negative charges among individual atoms (or
molecules) are subjected to forces in direction opposite. The
electric charge on the side opposite to the direction of the
electric field is negatively biased and the electric charge on
the side of the electric field is positively biased. This is called
polarization [8]. The value of complex permittivity of blood
depends on how the atoms (or molecules) in the blood are
polarized when an electric field is applied from the outside.
It can be expressed by a secondary Debye dispersion formula
with two relaxation time constants [7]. Since almost half of
the blood components are water [9], the water content of blood

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7348 IEEE SENSORS JOURNAL, VOL. 20, NO. 13, JULY 1, 2020

permittivity εr and conductivity σ

σ σ
ε˙r = εr − j εr = εr − j = εr (1 − j ). (1)
ωε0 ωε0 εr
In addition, it is known that Lichtenecker’s exponential law
holds for εr in a composite dielectric material. We can thus
express εr for any dielectric material as [18]
α 1−α
εr = εrw εrm (2)
where εrw is the relative permittivity of water, εrm is the
relative permittivity of other materials excluding water in the
Fig. 1. Block diagram for monitoring the water content of blood during blood, and α is the water content of blood, i.e., the ratio of
hemodialysis. water volume to total volume. Also, if the frequency band is
limited, we can use the first order Debye approximation to
express the complex relative permittivity ε̇rm as
is one of determinants of the complex permittivity of blood. εm εm 2π f τm εm
For example, to monitor the water content in plant leaves, ε̇rm = = −j (3)
1+ j 2π f τm 1+(2π f τm ) 2 1+(2π f τm )2
a method using the absorption spectra of water molecules
in the terahertz band was developed in [10], [11]. From the where εm is the magnitude of dispersion, and τm is the
obtained permittivity, it is deduced that the leaf specimens relaxation time constant. Then the relative permittivity of
increasingly become transparent to the terahertz waves as they blood can be expressed as a function of water content of blood
dry out with the passage of days. Therefore, the water content α as follows
 1−α
of blood can be estimated based on its complex permittivity. α εm
εr = εrw (4)
Fig. 1 shows a block diagram for monitoring the water 1 + (2π f τm )2
content in the blood during hemodialysis. A dielectric probe is
where the three parameters εm , τm , and α need to be
inserted into the blood (location A) or waste liquid (location B)
estimated. This approach was previously used to represent
in the dialyzer to measure the complex permittivity, and
the change in complex permittivity with child growth and
based on this the water content of blood is estimated. This
has proven its usefulness in [19]. By fitting the measured
information of water content is helpful to set an appropriate
relative permittivity as a function of frequency to Eq. (4) with
dialysis time for hemodialysis patients. In this study, we focus
the least-square method, we can obtain the water content of
on the feasibility analysis of estimating the water content of
blood α.
blood based on its complex permittivity which is measured
using a network analyzer and an open-ended coaxial probe.
The open-ended coaxial probe method has been widely used to III. V ERIFICATION U SING A PPLE J UICE
measure the complex permittivity of dielectric materials over a To verify the feasibility of the proposed estimation method,
broad range of frequencies [12]–[15], and several attempts in we employed a network analyzer and an open-ended coax-
the microwave and millimeter wave bands to estimate the glu- ial probe (SPEAG, DAK-12) for the complex permittivity
cose in the blood have already been reported [16], [17]. Here measurement. The end of the probe was inserted into the
we employ microwave band, and introduce Lichtenecker’s liquid sample and the reflection coefficient (S11 or ) was
exponential law [18] to express the Debye-approximated com- measured as a function of frequency using the vector network
plex permittivity. We first verify the validity of the proposed analyzer. The measured S11 or was then converted to the
method using apple juice and aqueous solution of glucose complex relative permittivity using an analytical model. Under
with known water content, and then we apply the method to the assumption that the sample is electrically infinite in size,
estimate the water content of blood for hemodialysis patients. the equivalent circuit of the open-ended coaxial probe can be
In addition, we will also investigate the correlation between considered as parallel of a lossy capacitor C0 ε˙r where C0 is
the estimated water content and the hematocrit in the blood the capacitance in air and a capacitor C f which accounts for
to investigate the possibility of anemia state examination. The the fringing effect in the Teflon. This equivalent circuit is valid
novelty of this study is to use Lichtenecker’s exponential law when the dimensions of the probe are small compared with
to express the relationship between the complex permittivity the wavelength so that the open end of the coaxial cable is
and the water content, and based on it to estimate the water not radiating. Then the reflection coefficient at the contact
content of the blood. Another novelty is the successful appli- plane of the discontinuity can be expressed as [12]
cation of this technique to monitoring water content of blood 1 − j ωZ 0 (C0 ε˙r + C f )
during dialysis for hemodialysis patients. = (5)
1 + j ωZ 0 (C0 ε˙r + C f )
where Z 0 is the characteristic impedance of coaxial cable, and
II. E STIMATION M ETHOD the complex relative permittivity ε˙r can be solved as
In general, the electric properties of human body are 1− Cf
ε˙r = − . (6)
expressed as complex relative permittivity with relative j ωZ 0C0 (1 + ) C0

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SHI et al.: MONITORING WATER CONTENT OF BLOOD DURING HEMODIALYSIS BASED ON COMPLEX
Fig. 2. Setup of complex permittivity measurement and water content
estimation.
TABLE I
B RIX VALUE AND WATER C ONTENT OF A PPLE J UICE
This technology has since been extended to higher frequencies
and measurement accuracy has been improved [13]–[15], but
the basic principle is as described above.
Fig. 2 shows the setup of complex permittivity measure-
ment and water content estimation. The picture was taken
for validation experiment with juice and aqueous solution of
glucose. At first, we employed a kind of apple juice of 100%
pure fruit as a sample. Then we diluted it with pure water
and produced another two kinds of diluted samples. So each
sample was mainly composed of water and sugar content, and
a Brix meter was used to measure the Brix value defined as
a value corresponding to the mass percentage of the sucrose
solution at 20o C. The water content in each sample was then
converted from the Brix value based on the density of sucrose
of 1.587g/cm3. Table I shows the measured Brix values and
converted water contents for the samples. Similar to blood,
juice is also composed of the water content and other contents.
Why we used juice for validation is because we can know its
correct water content using a Brix meter. In addition, there is
no difference in composition between apple juice and other
juices, since they all made of water and other ingredients.
The apply juice used was commercially available, and its
ingredients were 100% from apple.
The calibration procedure consists of two steps. The first
step is to calibrate the dielectric probe and the network
analyzer. The dielectric probe is connected to short and open
terminals, respectively, and inserted into pure water to perform
the calibration process of S-parameter and complex permittiv-
ity measurement. The second step is a calibration to determine
the two parameter εm and τm in the Debye expression. But
this step is not always possible, especially in actual use. It can
be omitted as described later. In that case, only the first step
is required in the calibration process.
Fig. 3 shows the curves of relative permittivity versus
frequency from 2.5 to 3.0 GHz, measured using the network
analyzer and dielectric probe, for pure water and 100%
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7349
Fig. 3. Measured relative permittivity of pure water and apple juice.
TABLE II
PARAMETERS OF A PPLE J UICE D ETERMINED BY C ALIBRATION
TABLE III
E STIMATED WATER C ONTENT OF J UICE S AMPLES W ITH C ALIBRATION
apple juice. The curves of the relative permittivity versus
frequency for the diluted juices are between the two curves,
although they are not shown to avoid having too many curves
to make the figure difficult to see. The relative permittivity of
the pure water agrees with the theoretical value [20], and the
relative permittivity of apple juice decreases when decreasing
the water content or increasing the sugar content.
As the first step of verification, we employed the 100%
apple juice with known water content (91.5%) for calibration.
The calibration aimed to determine the two parameters of
εm and τm of sugar by Eq. (4) with known α. Applying
the least-square-method-based curve fitting tool in Matlab to
the measured relative permittivity values of 100% apple juice,
we determined the two parameters εm and τm of sugar.
Table II shows the determined two parameters from the 100%
apple juice. The two parameters were assumed not to change
when diluting the juice with pure water.
After knowing the two parameters of εm and τm of sugar
by calibration, we used the proposed method to estimate
the water contents for the two diluted juice samples based
on the measured relative permittivity. Table III shows the
estimation results of water content. Also shown in the table for
comparison are the converted water content from Brix values.
As can be seen, the estimated water contents are within a
range of difference of 1% from the Brix meter’s results. So the
method is feasible to estimate the water content as long as a
calibration is adequately conducted.
7350
TABLE IV
E STIMATED WATER C ONTENT OF J UICE
S AMPLES W ITHOUT C ALIBRATION
TABLE V
SSE AT D IFFERENT F REQUENCY R ANGES
However, it is not always possible to know the parameter
α in advance. In that case the above-described calibration
is impossible. As a more general case of verification,
we attempted to estimate the three parameters εm , τm and
α simultaneously using the least-square method, and verified
whether or not the water content can be estimated without cal-
ibration. That is to say, the three parameters were determined
to have the smallest sum of squared errors
 

n
εm
α
SSE = εrme ( f i ) − εrw
1 + (2π f i τm )2
i=1
where εrme ( f i ) is the measured relative permittivity at the
sampling frequency f i .
To improve the accuracy of estimation, the three parameters
to be estimated were limited to their reasonable ranges based
on their physical meaning. Table IV shows the estimation
results of water content for the juice samples without cal-
ibration in advance. As can be seen, the estimated water
contents are within a difference range of 4% from the values
of Brix meter. This suggests that the method is still feasible to
estimate the water content even in the case that a calibration
is impossible.
In addition, the estimation of water content used the mea-
sured complex permittivity from 2.5 to 3.0 GHz. The reason
for choosing this frequency range was actually examined in
advance for the dependence of the estimation accuracy from
1.0 to 3.0 GHz. At lower frequencies such as MHz band the
wavelength is large, which increases the size of the dielectric
probe and the volume of the sample liquid. So it is inconve-
nient to use. At frequencies higher than the GHz band, the net-
work analyzer is more expensive. Table V shows the SSE for
the frequency ranges of 1.0 to 1.5 GHz, 1.5 to 2.0 GHz,
2.0 to 2.5 GHz, and 2.5 to 3.0 GHz. As can be seen, the SSE
was smallest in the frequency range of 2.5 to 3.0 GHz,
i.e., within 1%. We therefore chose this frequency range which
is the upper limit of the dielectric probe used. The higher the
frequency used, the less sample is required.
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IEEE SENSORS JOURNAL, VOL. 20, NO. 13, JULY 1, 2020
Fig. 4. Measured relative permittivity for five kinds of aqueous solutions
of glucose.
TABLE VI
PARAMETERS OF G LUCOSE D ETERMINED BY C ALIBRATION
IV. V ERIFICATION U SING AQUEOUS
S OLUTION OF G LUCOSE
Before applying the proposed estimation method to blood,
we first conducted further verification with aqueous solution
1−α 2 of glucose. We produced five kinds of aqueous solutions
(7) of glucose by mixing the glucose in pure water. The water
content in each aqueous solution of glucose was changed
from 60% to 75%, which was obtained by mixing the glucose
and pure water based on their volume ratio. Fig. 4 shows the
measurement results of relative permittivity of the five kinds
of aqueous solutions of glucose as a function of frequencies
from 2.5 to 3.0 GHz by using the network analyzer and
open-ended coaxial probe. As can be seen, the relative permit-
tivity decreases slowly between 2.5 and 3.0 GHz, and increases
as the water content increases. With the measured permittivity
versus frequency, we estimated the water content in the cases
with calibration and without calibration, respectively. In the
case with calibration, we employed the sample E with the
lowest water content for calibration, and estimated the water
content of other four kinds of samples. Table VI shows the
parameters of εm and τm at 2.5 - 3.0 GHz determined
by the least-square method. Tables VII and VIII shows the
estimation results of water content with calibration and without
calibration, respectively. As can be seen, the estimated water
contents are within an error range of 8% in the case with
calibration and 9% in the case without calibration. These
results suggest that the water content in a liquid sample can
be estimated with a reasonable accuracy.
V. M EASUREMENT OF WATER C ONTENT OF B LOOD
Fig. 5 shows two measurement results of real and imaginary
parts of the complex permittivity of blood for two human
subjects (Subject A and Subject B) at 25o C. It can be seen
that the real part εr , i.e., the relative permittivity εr , exhibits
SHI et al.: MONITORING WATER CONTENT OF BLOOD DURING HEMODIALYSIS BASED ON COMPLEX
TABLE VII
E STIMATED WATER C ONTENT OF AQUEOUS S OLUTIONS
OF G LUCOSE W ITH C ALIBRATION
TABLE VIII
E STIMATED WATER C ONTENT OF AQUEOUS S OLUTIONS
OF G LUCOSE W ITHOUT C ALIBRATION
Fig. 5. Two examples of measurement results of complex permittivity of
blood.
more obvious differences among individuals in this frequency
range, and is quite similar to the aqueous solution of glucose
in Fig. 4. Since it is difficult to calibrate the blood with
Brix meter, we estimated the water content of blood without
calibration. As shown before, the frequency band used for
estimation was set to 2.5 - 3.0 GHz. The sample’s volume
of blood required for measurement was 2.5 ml at least based
on [5]. In addition, based on Lichtenecker’s exponential law
in Eq. (2), the relative permittivity εrm of the other materials
excluding water in the blood can be expressed as
 
1 α
εrm = exp log εr − log εrw (8)
1−α 1−α
From Eq. (8), we drew out the relative permittivity εrm as
a function of frequency when the water content α of blood
was assumed to know. The frequency characteristic of εrm
for α = 0.5 is shown in Fig. 6. As can be seen, expressing
εrm using the first order Debye approximation is sufficient
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7351
Fig. 6. Relative permittivity versus frequency for blood, water, and the
other materials in the blood.
TABLE IX
G ENDER AND AGE OF 18 H EMODIALYSIS PATIENTS
TABLE X
E STIMATED WATER C ONTENTS OF B LOOD FOR 18
H EMODIALYSIS PATIENTS B EFORE D IALYSIS
between 2.5 and 3.0 GHz, and therefore expressing the relative
permittivity of blood using Eq. (4) is also reasonable.
Using the estimation method without calibration described
in Section III, we estimated the water contents of blood for
18 hemodialysis patients. Table IX shows the gender and age
of the 18 hemodialysis patients. It can be seen that both male
and female subjects were included and the ages ranged from
34 to 80 years old. The estimation of water content was based
on individual complex permittivity, so that the estimation
results were different due to individual difference. However,
the influence of gender and age on estimation accuracy is
not noticeable. Table X shows the estimated water contents
of blood and the corresponding parameters of εm and τm
for the 18 hemodialysis patients before dialysis, and Table XI
shows the average and standard deviation of the water contents
7352
TABLE XI
AVERAGE AND S TANDARD D EVIATION OF WATER C ONTENT OF B LOOD
Fig. 7. Change of water content before and after hemodialysis for
18 hemodialysis patients.
of blood and other parameters. As can be seen, the variations
in εm and τm are small which suggests an insignificant
individual difference in the blood. We further compared the
estimated water contents for the 18 hemodialysis patients
before and after hemodialysis. Fig. 7 shows the results. It can
be seen that the water content decreased for all the patients by
the hemodialysis. The estimated water contents of blood are
between 35% and 45% after dialysis, which basically falls in
the range of usual value of water content of blood. Therefore,
a change in water content of blood was indeed estimated
from a change in complex permittivity of blood, and there
is sufficient possibility of using it for real time monitoring of
the amount of water during hemodialysis.
VI. C ORRELATION OF WATER C ONTENT
W ITH H EMATOCRIT
In addition, it is also possible to link the water content to
other biochemical components of the hemodialysis patients.
Hematocrit is a numerical value indicating the ratio of the
volume of blood cells in the blood. It is almost equal to the
volume ratio of erythrocytes, and is usually used for anemia
examination. If the water content of blood is large (the blood
is thin), the hematocrit will decreases, so that a negative
correlation should be observed. This suggests a possibility
of also observing the hematocrit of hemodialysis patients
from the water content of blood. In view of the usefulness
of hematocrit for anemia examination, we investigated the
correlation between the water content and hematocrit. The
values of hematocrit for the 18 homedialysis patients were
measured by usual biochemical analysis in a hospital, and
the water contents of blood were obtained in the previous
section. As a result, the correlation relationship between the
water content of blood and the hematocrit is shown in Fig. 8.
The correlation coefficient between them was found as −0.8,
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IEEE SENSORS JOURNAL, VOL. 20, NO. 13, JULY 1, 2020
Fig. 8. Correlation between the water content of blood and hematocrit.
which suggests a strong correlation. This result is identical
to the fact that the hematocrit will decreases as the blood
becomes thin. So it is also possible to observe the hematocrit
and then the anemia state from the water content of blood
based on complex permittivity measurement during dialysis.
VII. C ONCLUSION
In this paper, we have proposed a method for estimating
the water content of blood during dialysis based on the
complex permittivity measured using a network analyzer and
an open-loaded probe. To verify its effectiveness, we have first
applied this method to apple juice and then to an aqueous
solution of glucose. The results have shown that the measure-
ment error is within 9% regardless of whether a calibration
solution could be prepared. We have applied this method
to monitor the water content of blood for 18 hemodialysis
patients during dialysis. The water contents after dialysis have
shown an obvious decrease in the blood, ranging between
35% and 45%, that roughly fall in the reasonable range of
water content of blood. Moreover, the correlation analysis
between the water content and the hematocri in the blood
has shown a strong correlation with a correlation coefficient
as high as −0.8. These results demonstrate the feasibility to
monitor the water content of blood as well as the hematocrit or
anemia state based on the complex permittivity measurement
during dialysis.
One limitation of the proposed method is that in most cases
we have to estimate the three parameters εm , τm and the
water content α at the same time. This does not guarantee
that the solution is unique, and some estimation errors may
occur if the estimation range is not properly chosen. Another
limitation is the use of expensive network analyzer. To make
the method more practical, a compact complex permittivity
measurement sensor is required instead of a network analyzer,
and its implementation is our future subject.
ACKNOWLEDGMENT
The authors would like to thank Dr. A. Takeda, Chubu
University, Japan, for providing the blood samples.
SHI et al.: MONITORING WATER CONTENT OF BLOOD DURING HEMODIALYSIS BASED ON COMPLEX
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Jingjing Shi (Member, IEEE) received the B.E.
degree from the Shenyang University of Chem-
ical Technology, Shenyang, China, in 2007, and
the M.E. and D.E. degrees from the Nagoya Insti-
tute of Technology, Nagoya, Japan, in 2010 and
2013, respectively.
She was a Postdoctoral Research Associate
and then an Assistant Professor at the Nagoya
Institute of Technology from 2013, prior to join-
ing Northeastern University, Shenyang, China,
in 2017. She is currently with Northeastern Uni-
versity as an Associate Professor. Her research interests involve biomed-
ical communications in wireless communication networks and biomedical
EMC issues.
Shinnosuke Seo received the B.E. and M.E
degrees in electrical and electronic engineering
from the Nagoya Institute of Technology, Nagoya,
Japan, in 2015 and 2017, respectively.
As a Graduate Student at the Nagoya Insti-
tute of Technology, he was involved in complex
permittivity measurement and estimation. He is
currently with Shimadzu Corporation, Japan.
Jianqing Wang (Senior Member, IEEE)
received the B.E. degree in electronic engi-
neering from the Beijing Institute of Technology,
Beijing, China, in 1984, and the M.E. and
D.E. degrees in electrical and communication
engineering from Tohoku University, Sendai,
Japan, in 1988 and 1991, respectively.
He was a Research Associate with Tohoku
University, and a Senior Engineer with Sophia
Systems Company, Ltd. In 1997, he joined the
Nagoya Institute of Technology, Nagoya, Japan,
where he has been a Professor, since 2005. He has authored Body Area
Communications (Wiley-IEEE) in 2012. He received the IEEE EMCS
Technical Achievement Award in 2019. His current research interests
include biomedical communications and electromagnetic compatibility.