Study examines volume overload in patients initiating peritoneal dialysis
A new study published in CJASN found substantial volume overload, or too much fluid in the body, in patients with kidney failure who initiated peritoneal dialysis. Volume overload tended to improve over time after starting dialysis, but was at all times was higher in males vs. females and in patients with diabetes vs. those without. The study also revealed variations in practice of care across different geographic regions. This variation was associated with differences in degree of volume overload.
Individuals with kidney failure who are undergoing hemodialysis or peritoneal dialysis often experience fluid overload. To examine the implications of this condition, Wim Van Biesen, MD, PhD (University Hospital Ghent, in Belgium) and his colleagues designed a study to assess patients’ health and fluid volume over time after initiating peritoneal dialysis. It’s thought that actively managing volume overload may reduce the risk of technique failure (transfer from peritoneal dialysis to hemodialysis) and prolong patient survival.
The article, entitled “Evolution Over Time of Hydration Status and PD Related Practice Patterns in an Incident Peritoneal Dialysis Patient Cohort,” will appear online at http://cjasn.asnjournals.org/ on May 23, 2019, doi: 10.2215/CJN.11590918.
In the study of 1,054 patients from 28 countries who were examined every 3 months, volume overload before the start of dialysis amounted to an average of 1.9 L and decreased to 1.2 L during the first year. After 3 years of follow-up, the average relative volume overload in patients was lower than at the start in participants from all regions except those of Latin American, where it increased. The investigators concluded that volume overload is already present before the start of dialysis, and it tends to improve over the first 6 months and stabilize afterwards.
At all time points, males and participants with diabetes were at a higher risk of experiencing volume overload. Also, volume overload was associated with a higher risk of premature death. The study revealed different treatment practices to address volume overload across dialysis centers and regions.
