Assessment of dry weight by monitoring changes in blood volume during hemodialysis using Crit-Line.

BACKGROUND: Routine assessment of dry weight in chronic hemodialysis patients relies primarily on clinical evaluation of patient fluid status. We evaluated whether measurement of postdialytic vascular refill could assist in the assessment of dry weight. METHODS: Twenty-eight chronic, stable hemodialysis patients were studied during routine treatment sessions using constant dialysate temperature and dialysate sodium concentration, and relative changes in blood volume were monitored using Crit-Line III monitors throughout this study. The study was divided into three phases. Phase 1 studies evaluated the time-dependence of vascular compartment refill after completion of hemodialysis. Phase 2 studies evaluated the relationships in patient subgroups between intradialytic changes in blood volume and the presence of postdialytic vascular compartment refill during that last 10 minutes of hemodialysis after stopping ultrafiltration. Phase 3 studies evaluated the extent of dry weight changes following the application of a protocol for blood volume reduction, postdialytic vascular compartment refill, and correlation with clinical evidence of intradialytic hypovolemia and/or postdialytic fatigue. Phase 3 included anywhere from three to five treatments. RESULTS: Phase 1 studies demonstrated that despite interpatient variability in the magnitude of postdialytic vascular compartment refill, when significant refill was evident, it always continued for at least 30 minutes. However, the majority of refill took place within 10 minutes postdialysis. Phase 2 studies identified 3 groups of patients: those who exhibited intradialytic reductions in blood volume but not postdialytic vascular compartment refill (group 1), those who exhibited intradialytic reductions in blood volume and postdialytic vascular compartment refill (group 2), and those whose blood volume did not change substantially during hemodialysis treatment (group 3). In phase 3 studies, use of an ultrafiltration protocol for blood volume reduction and monitoring of postdialytic vascular compartment refill combined with clinical assessment of hypovolemia and postdialytic fatigue demonstrated that patients often had a clinical dry weight assessment which was too low or too high. In all 28 patients studied, dry weight was either increased or decreased following use of this protocol. CONCLUSION: Determination of the extent of both intradialytic decreases in blood volume and postdialytic vascular compartment refill, combined with clinical assessment of intradialytic hypovolemia and postdialytic fatigue, can help assess patient dry weight and optimize volume status while reducing dialysis associated morbidity. The number of hospital admissions due to fluid overload may be reduced.

Effect of polymer concentration on stabilized large-tilt-angle flexoelectro-optic switching

In this letter, the uniform lying helix (ULH) liquid crystal texture, required for the flexoelectro-optic effect, is polymer stabilized by the addition of a small percentage of reactive mesogen to a high-tilt-angle (φ>60°) bimesogenic chiral nematic host. The electro-optic response is measured for a range of reactive mesogen concentration mixtures, and compared to the large-tilt-angle switch of the pure chiral nematic mixture. The optimum concentration of reactive mesogen, which is found to provide ample stabilization of the texture with minimal impact on the electro-optic response, is found to be approximately 3%. Our results indicate that polymer stabilization of the ULH texture using a very low concentration of reactive mesogen is a reliable way of ruggedizing flexoelectro-optic devices without interfering significantly with the electro-optics of the effect, negating the need for complicated surface alignment patterns or surface-only polymerization. The polymer stabilization is shown to reduce the temperature dependence of the flexoelectro-optic response due to "pinning" of the chiral nematic helical pitch. This is a restriction of the characteristic thermochromic behavior of the chiral nematic. Furthermore, selection of the temperature at which the sample is ultraviolet cured allows the tilt angle to be optimized for the entire chiral nematic temperature range. The response time, however, remains more sensitive to operating temperature than curing temperature. This allows the sample to be cured at low temperature and operated at high temperature, providing simultaneous optimization of these two previously antagonistic performance aspects. © 2006 American Institute of Physics.