Bioimpedance analysis and intradialytic hypotension in intermittent hemodialysis

Background: Intradialytic hypotension (IDH) is one of the most severe complications during hemodialysis. Its appearance is caused in part by rapid fluid removal with concomitant failure in blood pressure regulation but also by other dialytic-dependent and independent factors. Patients and methods: We investigated total (TBW), extracellular (ECW) and intracellular water (ICW) in chronic intermittent hemodialysis dialysis hypotension-prone (CRF-HP, n = 11) and nonhypotension-prone (CRF-NHP, n = 10) patients with end-stage renal disease before, every 30 minutes during, as well as after dialysis and within onset of intradialytic hypotension by multifrequent bioimpedance analysis (BIA). Additionally, intradialytic time course of BIA in patients with acute renal failure (ARF) and septic shock (n = 10) was observed. Results: IDH occurred in 72.1% of CRF-HP and in 80% of ARF patients. In CRF-HP and CRF-NHP, ECW significantly decreased by -12.44 +/- 4.22% in CRF-HP and -9.0 +/- 6.2% in CRF-NHP comparing pre- and post-dialysis values (each p < 0.01). Conversely, ICW increased by +11.51 +/- 11.3% in CRF-HP and +18.4 25.2% in CRF-NHP (each p < 0.05). In patients with ART no significant changes could be detected. Calculated ECW/ICW and ECW/TBW ratio significantly decreased in CRF patients with a higher rate in CRF-HP patients (p < 0.05). Neither ECW/ICW nor ECW/TBW ratio correlated with mean arterial pressure. The onset of intradialytic hypotension (n = 35) did not differ intraindividually compared to nonnotensive periods (n = 411). Fluid removal in CRF patients seems to be mainly from the extracellular space. The reduced decreases in ECW/ICW and ECW/TBW ratios in CRF-HP compared to CRF-NHP may indicate an insufficient refilling from intra- to extracellular compartment in CRF-HP. Conclusion: In conclusion, multifrequent BIA is not capable to predict hypotension in the individual patient during a particular dialysis session

Clinical judgment is the most important element in overhydration assessment of chronic hemodialysis patients

The assessment of hydration status remains a challenging task in hemodialysis (HD) management. There are only limited data available on the relevance of clinical decisions in the estimation of dialysis overhydration (OH). The objective of this study was to examine the significance of clinical judgment in the assessment of pre-dialysis OH. We compared the performance of three methods of OH assessment: (1) clinical judgment guided by a single clinical examination with (2) multifrequency bioimpedance analysis (BIA) and (3) complex systematic clinical approach. We additionally studied the associations of these methods with selected laboratory and imaging parameters. Any of the single parameters alone reached a sufficient level of accuracy for reliable prediction of OH. Clinical judgment was the single most important factor in OH estimation, and also had the highest contribution when in combination with other parameters. BIA reliably measured extracellular fluid, but the automatically calculated OHBIA exhibited a substantial degree of inaccuracy that precludes the use of BIA as a standard at present. The combination of clinical judgment with additional clinical parameters had the highest prediction accuracy for OH. Among the parameters studied, vena cava collapsibility index and calf circumference showed the strongest association with OH. Echocardiography, cardiothoracic index, atrial natriuretic peptide levels and spirometry did not have acceptable sensitivity. The systematic clinical approach combining physician and patient inputs, laboratory and imaging data enables an individualized decision and a superior accuracy in OH assessment

Surface Molecular Imprinting in Layer-by-Layer films on Silica Particles

An improvement to molecular imprinting in polymers, where bulk systems often suffer from slow dynamics of release and uptake, is the formation of thin films with imprinting sites that are more rapid to access by guest molecules. Based on our previous development of surface molecular imprinting layer-by-layer (LbL) films (SMILbL), the present paper presents selective imprinted sites in a surface film on dispersed silica particles, thus designing a SMILbL system with maximized active area and in addition allowing studies with bulk techniques. The multilayer is designed to include the template during the LbL buildup and to form a cross-linked network upon UV-irradiation for enhanced stability. A theophylline moiety is grafted to poly­(acrylic acid) as the template, while a UV-sensitive diazo polycation cross-links the polymers after irradiation. Electrophoretic measurements prove the successful buildup of the multilayers by an alternating sign of the zeta potential. Template release is achieved by cleavage of the grafted template. The released amount of template is quantified in solution by ¹H NMR spectra and is in good agreement with the prediction from surface coverage calculations. Rebinding studies of template to the now empty imprinted binding sites show a high affinity for a theophylline derivative with a rebound amount on the order of the original template content. In contrast to theophylline, caffeine with a very similar chemical structureonly differing in one functional groupshows very different binding properties due to a thiol moiety in the binding site. Thus, a particle system with very selective molecular imprinting sites is demonstrated