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Washington, DC (May 23, 2019) – A new study published in CJASN has revealed a substantial volume overload, or too much fluid in the body, in patients with renal insufficiency who initiated peritoneal dialysis. Volume overload tended to improve over time after dialysis started, but was still higher in men than in women and in diabetic patients compared to others. The study also revealed variations in the practice of care from one geographic area to the next. This variation was badociated with differences in degree of volume overload.
People with kidney failure who undergo hemodialysis or peritoneal dialysis often experience fluid overload. To examine the implications of this disease, Wim Van Biesen, MD, Ph.D. (Ghent University Hospital, Belgium) and colleagues designed a study to badess the health and fluid volume of patients over time after the start of peritoneal dialysis. It is thought that active management of volume overload could reduce the risk of failure of the technique (switching from peritoneal dialysis to hemodialysis) and prolong patient survival.
In the study of 1,054 patients from 28 countries who were examined every 3 months, the volume overload before dialysis started increased to 1.9 L on average and decreased to 1.2 L during the first year. After 3 years of follow-up, the average relative volume of overload in patients was lower than that observed initially in all regions, with the exception of Latin America, where it had increased. The investigators concluded that the volume overload already existed prior to the start of dialysis and that it tends to improve over the first six months and stabilize thereafter.
At all times, men and diabetic participants were at greater risk for volume overload. In addition, volume overload was badociated with a higher risk of premature death. The study revealed different treatment practices for treating volume overload in dialysis centers and regions.
"We had the intention of badociating peritoneal dialysis practices – use of hypertonic exchanges, the use of automated peritoneal dialysis to continuous ambulatory peritoneal dialysis, the use of intravenous dialysis. icodextrin and the use of diuretics – with technical failure.Our main finding is that the badociation between technical failure and fluid overload depend on the size of the center and therefore presumably of the same. experience of the treatment center, "said Dr. Van Biesen.
In an accompanying Patient Voice editorial, Shari Gilford shared her peritoneal dialysis experience, both ambulatory and automated, for 7 years. She also asked why patients in Latin America had different results from other regions.
"If there are factors other than the type of dialysate, the dialysate concentrate or the diet that make it more difficult for patients to control their volume overload, you must inform the patients," she said. written. "Based on my own experience [in hot vs. cold seasons], I wonder if the warmer climate of all of Latin America throughout the year, unlike most other areas of the study where the season is cold, could have been a factor of fluid overload leading to increased mortality. Further study of this variable may improve outcome in peritoneal dialysis patients living in warmer climates. "
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The co-authors of the study are: Christian Verger, MD, James Heaf, MD, PhD, Francois Vrtovsnik, MD, PhD, Zita Leme Britto, MD, Jun-Young Do, MD, PhD, Mario Prieto Velasco, MD, PHD and Juan Pérez Martínez. , MD, PhD, Carlo Crepaldi, MD, PhD, Tatiana De los Rios, Adelheid Gauly, PhD, Katharina Ihle and Claudio Ronco, MD, PhD, for the IPOD-PD Study Group.
Disclosures: The study was sponsored by Fresenius Medical Care, the manufacturer of the BCM® device used to badess the status of fluids and nutritional status. Tatiana De los Rios, Adelheid Gauly and Katharina Ihle are employees of Fresenius Medical Care. The other authors have not reported any conflict of interest in the financial field.
The article titled "Evolution over time of hydration status and MP-related practice models in a cohort of incident peritoneal dialysis patients" will appear online at http: / / cjasn.
The editorial, titled "Management of Fluid Control in the Peritoneal Dialysis Population", will be posted online at http://cjasn.nl.
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