New research indicates that sustained fluid overload may increase the risk of early death in kidney failure patients on hemodialysis. Sustained fluid overload can have a variety of consequences, including swelling, discomfort, hypertension, and heart problems. Although it is a major cause of concern for patients with kidney failure who are on hemodialysis, only a few small studies have looked at the relationship between fluid overload and premature death in these patients.

Carmine Zoccali, MD,  from CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Italy, and his colleagues examined an extensive clinical database of a large international dialysis network.

The team’s analyses were based on more than 200,000 measurements of fluid status in 39,566 patients initiating hemodialysis in 26 countries in Europe, Africa, the Middle East, and Latin America. Their findings appear in the article entitled “Chronic fluid overload and mortality in ESRD,” published in an upcoming issue of the Journal of the American Society of Nephrology.

The researchers studied the relationship between fluid overload measured just once at the start of regular dialysis treatment and mortality, as well as the relationship between cumulative exposure to fluid overload over one year and mortality.

They found that cumulative fluid overload over one year predicted a higher risk of death than the single measurement made at the start of regular dialysis treatment.

“Ours is the first study providing information about the risk of persistent fluid overload in dialysis patients,” said Zoccali. “Remarkably, the excess risk for death attributable to persistent fluid overload was similar to the risk observed with coronary artery disease, heart failure, and being 12 years older.”

Study co-authors include Ulrich Moissl, PhD, Charles Chazot, MD, Francesca Mallamaci, MD, Giovanni Tripep, Dr Biostat, PhD, Otto Arkossy, MD, Peter Wabel, PhD, and Stefano Stuard, MD, PhD.