Physical impairment is a highly prevalent and progressive problem that contributes to a significantly lower quality of life experienced by patients with end-stage renal disease (ESRD) undergoing thrice weekly hemodialysis. Observational data has shown that improper fluid management is a likely contributor to physical impairment, but lack of data on the relative importance of the many fluid-related components of dialysis therapy (e.g. intradialytic weight gain, baseline fluid overload, intradialytic blood pressure, ultrafiltration rate, and target weight achievement) has limited consensus and evidence-based guideline development. The Dialysis Rx to Yield Optimal UltrafilTration (DRYOUT) study is a proposed observational analysis of adult patients with ESRD receiving hemodialysis in San Francisco. The major goal of this study is to identify which elements of fluid overload, and its subsequent removal on dialysis, serve as the strongest predictors of physical performance. Identification of these risk factors may guide future clinical trials testing different fluid management strategies to improve how patients feel and function while on hemodialysis.
This proposal, entitled Dialysis Rx to Yield Optimal UltrafilTration (DRYOUT), is an observational clinical research study on the effectiveness of fluid management among patients on chronic dialysis. The goal is to identify risk factors that contribute to the significant morbidity associated with physical impairment experienced by patients with end-stage renal disease. This study holds the promise of clarifying which elements of fluid management are the most important targets for intervention when trying to prevent functional status decline, and findings may be useful when designing future trials of different fluid management strategies to improve patient-centered outcomes.
