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Volume Overload Linked to Peritoneal Dialysis Outcomes

Patients undergoing either peritoneal or haemodialysis often present with fluid overload; i.e., retention of excessive amounts of water within the body. The international variation in this phenotype, and whether it directly impacts on the outcomes of the dialytic patient, were previously unknown. A team of researchers from University Hospital Ghent, Ghent, Belgium, sought to answer these questions through a study measuring patients’ health and fluid volume over time after initiating dialysis.

The study involved 1,054 patients across 28 countries who were examined periodically every 3 months. An average of 1.9 litres overload was measured across the whole cohort before the start of dialysis, which by the first year had reduced to an average of 1.2 litres. Regardless of this improvement, males universally exhibited increased overload compared to females, a trend also seen when comparing diabetics to non-diabetics. Interestingly, the amelioration of overload applied to all regions except Latin America, where it increased over time. The volume overload was also persistently associated with higher risk of premature death.

The group were additionally able to determine different practices across clinics that can be optimised for treatment of these patients (e.g., the use of diuretics and hypertonic exchanges). Dr Wim Van Biesen, University Hospital Ghent, lead investigator of the study, summarised: “Our main finding is that the association between technique failure and fluid overload is dependent upon centre size and thus presumably experience within the treating centre.”

Shari Gilford provided her personal account of 7-year peritoneal dialysis as an accompanying Patient Voice editorial. Commenting on the Latin American finding, she stressed the importance of patients knowing whether there are factors outside of dialysate type/concentrate or diet that can help them control their volume overload. She speculated that the hotter climate in Latin America may be negatively affecting dialytic patients, but more research is required to confirm this hypothesis.