Evolution Over Time of Volume Status and PD-Related Practice Patterns in an Incident Peritoneal Dialysis Cohort

Abstract

Background and objectivesVolume overload is frequent in prevalent patients on kidney replacement therapies and is associated with outcome. This study was devised to follow-up volume status of an incident population on peritoneal dialysis (PD) and to relate this to patient-relevant outcomes.Design, setting, participants, & measurementsThis prospective cohort study was implemented in 135 study centers from 28 countries. Incident participants on PD were enrolled just before the actual PD treatment was started. Volume status was measured using bioimpedance spectroscopy before start of PD and thereafter in 3-month intervals, together with clinical and laboratory parameters, and PD prescription. The association of volume overload with time to death was tested using a competing risk Cox model.ResultsIn this population of 1054 participants incident on PD, volume overload before start of PD amounted to 1.9±2.3 L, and decreased to 1.2±1.8 L during the first year. At all time points, men and participants with diabetes were at higher risk to be volume overloaded. Dropout from PD during 3 years of observation by transfer to hemodialysis or transplantation (23% and 22%) was more prevalent than death (13%). Relative volume overload >17.3% was independently associated with higher risk of death (adjusted hazard ratio, 1.59; 95% confidence interval, 1.08 to 2.33) compared with relative volume overload ≤17.3%. Different practice patterns were observed between regions with respect to proportion of patients on PD versus hemodialysis, selection of PD modality, and prescription of hypertonic solutions.ConclusionsIn this large cohort of incident participants on PD, with different treatment practices across centers and regions, we found substantial volume overload already at start of dialysis. Volume overload improved over time, and was associated with survival.

Determinants of volume status in peritoneal dialysis: A longitudinal study

“…Specifically, extracellular volume control did not vary with time once accounting for potential confounders. An earlier large study of incident PD patients also reported stable extracellular volume status over time 27 . We also tested the effect of numerous variables on the evolution of extracellular volume status over time, but were unable to demonstrate any demographic or other factor having any effect.…”

Association between Dialysis Modality and Cardiovascular Diseases: A Comparison between Peritoneal Dialysis and Hemodialysis

“…Fluid overload is common in PD patients [37][38][39][40][41][42][43][44] and an independent predictor of all-cause mortality [39,42]. Ng et al [41] reported that fluid overload was common in asymptomatic incident PD patients and a strong predictor of patient survival and cardiovascular events.…”

Assessment of Hydration Status in Peritoneal Dialysis Patients: Validity, Prognostic Value, Strengths, and Limitations of Available Techniques

“…The study revealed that the majority (56.4%) of patients were moderately and severely overhydrated based on a cutoff level of >1.1 L. At initiation of PD, the mean OH volume was 1.9 ± 2.4 L; however, 1 year later, OH had decreased at 1.2 ± 1.8 L and remained relatively stable between the 2nd and 3rd year of follow-up (1.4 ± 1.8 L and 1.4 ± 1.7 L, respectively). According to a linear-mixed model analysis, age, male gender, and presence of diabetes were associated with fluid overload at 1st month (adjusted difference in relative OH at 1st month for age: 0.1, 95% CI 0.0–0.1 per 1 year of increase; for male gender: 3.4, 95% CI 2.1–4.7; for presence of diabetes: 4.8, 95% CI 3.3–6.2) [70]. Of note, BIA techniques showed that PD patients presented with higher ECW content compared with HD patients, while studies with serum biomarkers indicated no differences in their levels between PD and HD [9, 71].…”