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.

Background Technique failure in peritoneal dialysis (PD) can be due to patient- and procedure-related factors. With this analysis, we investigated the association of volume overload at the start and during the early phase of PD and technique failure. Methods In this observational, international cohort study with longitudinal follow-up of incident PD patients, technique failure was defined as either transfer to haemodialysis or death, and transplantation was considered as a competing risk. We explored parameters at baseline or within the first 6 months and the association with technique failure between 6 and 18 months, using a competing risk model. Results Out of 1092 patients of the complete cohort, 719 met specific inclusion and exclusion criteria for this analysis. Being volume overloaded, either at baseline or Month 6, or at both time points, was associated with an increased risk of technique failure compared with the patient group that was euvolaemic at both time points. Undergoing treatment at a centre with a high proportion of PD patients was associated with a lower risk of technique failure. Conclusions Volume overload at start of PD and/or at 6 months was associated with a higher risk of technique failure in the subsequent year. The risk was modified by centre characteristics, which varied among regions.

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Fragestellung: Ist der Anstieg der Krankenhausbehandlungen Jugendlicher wegen einer Alkoholintoxikation ein Indikator für eine Zunahme riskanten Trinkverhaltens? Methodik: Durchgeführt wurden zwei Sekundäranalysen (Untersuchung der Straftaten und Unfälle unter Alkoholeinfluss von 10 – 20-jährigen Jugendlichen sowie der Blutalkoholkonzentrationen (BAK) von stationär behandelten Jugendlichen, n = 1 020) und eine Feldstudie (Bevölkerungsbefragung, n = 285). Ergebnisse: Die Zahl der Krankenhausbehandlungen korrelierte positiv mit den Straftaten, jedoch nicht mit den Unfällen unter Alkoholeinfluss. In einer Stadt mit hohen Behandlungszahlen würden mehr Studienteilnehmer in Notfallsituationen als Erstes den Rettungsdienst verständigen als in einer vergleichbaren Stadt mit geringen Behandlungszahlen. Die durchschnittlichen BAK sanken innerhalb eines Zweijahreszeitraums (2008 – 2009) kontinuierlich. Schlussfolgerungen: Die Entwicklung von Krankenhausbehandlungen und Straftaten unter Alkoholeinfluss sprechen für einen gestiegenen Risikokonsum. Die Zunahme der Behandlungen wegen Alkoholintoxikation ist jedoch mit einer erhöhten Sensibilisierung der Bevölkerung assoziiert und wird durch alkoholbezogene Unfallzahlen nicht unterstützt.

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