Kidney Failure Patients

A new study published in CJASN found substantial volume overload, or too much fluid in the body, in patients with kidney failure who initiate peritoneal dialysis. Volume overload tend 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.

Different geographic regions

The study also reveal variations in practice of care across different geographic regions. This variation was associate 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 design a study to assess patients health; also fluid volume over time after initiating peritoneal dialysis. It’s thought that actively managing volume overload; which may reduce the risk of technique failure (transfer from peritoneal dialysis to hemodialysis) and prolong patient survival.

In the study of 1,054 patients from 28 countries who were examine every 3 months; also volume overload before the start of dialysis amount to an average of 1.9 L and decrease to 1.2 L during the first year. After 3 years of follow up, the average relative volume overload in patients was lower; so than at the start in participants from all regions except those of Latin American, where it increased.

Participants with diabetes

The investigators conclude that volume overload is already present before the start of dialysis; also 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 associate with a higher risk of premature death. The study reveal different treatment practices to address volume overload across dialysis centers and regions.

In an accompanying Patient Voice editorial, Shari Gilford share her experience of peritoneal dialysis; so both ambulatory and automated, for 7 years. She also question why patients in Latin America had a different outcome; hence than those from other regions. If there are factors other than dialysate type, dialysate concentrate, or diet; which make it more difficult for patients to control their volume overload, patients need to be made aware of this, she wrote.

Base on my own experience [in hot vs. cold seasons]; so they wonder if the year round hotter climate of Latin America, as oppose to most other regions in the study which have cold seasons; so could have a factor for fluid overload leading to increase mortality. Continue study of this variable might improve outcomes for peritoneal dialysis patients who live in warmer climes.