A Meta-Analysis of Icodextrin versus Glucose Containing Peritoneal Dialysis in Metabolic Management of Peritoneal Dialysis Patients

He, Qiang; Zhang, Wei; Chen, Jianghua

doi:10.3109/0886022x.2011.615965

Cited by 10 publications

(4 citation statements)

References 23 publications

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“…The timing of blood collection for the measurement of fasting glucose (PD fluids drained out or dwelled) and the dwell times were inconsistent across the participants. Unfortunately, this is a common limitation of studies on MS in PD patients (47).…”

Section: Discussionmentioning

confidence: 99%

Associations between Serum-Intact Parathyroid Hormone, Serum 25-Hydroxyvitamin D. Oral Vitamin D Analogs and Metabolic Syndrome in Peritoneal Dialysis Patients: A Multi-Center Cross-Sectional Study

et al. 2014

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M etabolic syndrome (MS) consists of a cluster of metabolic and hemodynamic abnormalities. The components of MS such as abdominal obesity, high blood pressure, insulin resistance and dyslipidemia are risk factors for chronic kidney disease (CKD) (1,2), diabetes (3), cardiovascular disease (4) and high cardiovascular mortality (5). on the other hand, the components of MS develop early in CKD and are exacerbated during the progression to end-stage renal disease (eSRD) (6,7). The prevalence of MS is remarkably high in CKD patients, being approximately 30% -65% for non-dialysis patients (6-8) and 47% -69% for dialysis patients (9-12). MS represents a global epidemic and it is clearly important to explore new, non-traditional risk factors.In the general population, MS has been positively associated with serum intact parathyroid hormone (iPTH) (13-15) and negatively with vitamin D status, as measured using 25-hydroxyvitamin D (25(oH)D) concentrations (16)(17)(18)(19)(20). Decreased vitamin D levels and elevated iPTH levels may play critical roles in the etiology of MS, either through an association with the Correspondence to: Jie Dong,

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Section: Discussionmentioning

confidence: 99%

Associations between Serum-Intact Parathyroid Hormone, Serum 25-Hydroxyvitamin D. Oral Vitamin D Analogs and Metabolic Syndrome in Peritoneal Dialysis Patients: A Multi-Center Cross-Sectional Study

et al. 2014

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“…Three systematic reviews of randomized controlled trials (RCTs) have compared icodextrin-containing to glucose-only PD regimens. [40][41][42] However, their estimates of important outcomes such as mortality risk and hospitalization, as well as systemic metabolism and peritoneal function, have wide confidence intervals (CIs). This uncertainty may have arisen because of nonincluded evidence, such as unpublished data from published studies, studies published in non-English languages, and studies that have undergone regulatory as opposed to academic peer review.…”

mentioning

confidence: 99%

Icodextrin Versus Glucose Solutions for the Once-Daily Long Dwell in Peritoneal Dialysis: An Enriched Systematic Review and Meta-analysis of Randomized Controlled Trials

Goossen

Becker

Marshall

et al. 2020

American Journal of Kidney Diseases

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The efficacy and safety of icodextrin versus glucose-only peritoneal dialysis (PD) regimens is unclear. The aim of this study was to compare once-daily long-dwell icodextrin versus glucose among patients with kidney failure undergoing PD. Study Design: Systematic review of randomized controlled trials (RCTs), enriched with unpublished data from investigator-initiated and industry-sponsored studies. Setting & Study Populations: Individuals with kidney failure receiving regular PD treatment enrolled in clinical trials of dialysate composition. Selection Criteria for Studies: Medline, Embase, CENTRAL, Ichushi Web, 10 Chinese databases, clinical trials registries, conference proceedings, and citation lists from inception to November 2018. Further data were obtained from principal investigators and industry clinical study reports. Data Extraction: 2 independent reviewers selected studies and extracted data using a prespecified extraction instrument. Analytic Approach: Qualitative synthesis of demographics, measurement scales, and outcomes. Quantitative synthesis with Mantel-Haenszel risk ratios (RRs), Peto odds ratios (ORs), or (standardized) mean differences (MDs). Risk of bias of included studies at the outcome level was assessed using the Cochrane risk-of-bias tool for RCTs. Results: 19 RCTs that enrolled 1,693 participants were meta-analyzed. Ultrafiltration was improved with icodextrin (medium-term MD, 208.92 [95% CI, 99.69-318.14] mL/24 h; high certainty of evidence), reflected also by fewer episodes of fluid overload (RR, 0.43 [95% CI, 0.24-0.78]; high certainty). Icodextrin-containing PD probably decreased mortality risk compared to glucose-only PD (Peto OR, 0.49 [95% CI, 0.24-1.00]; moderate certainty). Despite evidence of lower peritoneal glucose absorption with icodextrin-containing PD (medium-term MD, −40.84 [95% CI, −48.09 to −33.59] g/ long dwell; high certainty), this did not directly translate to changes in fasting plasma glucose (−0.50 [95% CI, −1.19 to 0.18] mmol/L; low certainty) and hemoglobin A 1c levels (−0.14% [95% CI, −0.34% to 0.05%]; high certainty). Safety outcomes and residual kidney function were similar in both groups; health-related quality-of-life and pain scores were inconclusive. Limitations: Trial quality was variable. The followup period was heterogeneous, with a paucity of assessments over the long term. Mortality results are based on just 32 events and were not corroborated using time-to-event analysis of individual patient data. Conclusions: Icodextrin for once-daily long-dwell PD has clinical benefit for some patients, including those not meeting ultrafiltration targets and at risk for fluid overload. Future research into patient-centered outcomes and costeffectiveness associated with icodextrin is needed. T he prevalence of kidney replacement therapy is expected to increase steeply. 1 Approximately 15% of dialysis patients globally use peritoneal dialysis (PD), and this proportion is increasing. 2 PD is probably associated with the same survival as hemodialysis (HD) 3-6 but pre...

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“…Various systematic reviews have shown variable results on the impact of icodextrin on peritoneal transport status or peritoneal creatinine clearance. Earlier meta‐analyses by Qi et al 65 and He et al 76 suggested that icodextrin improved small solute clearance; however, more recent meta‐analyses did not show any effect of icodextrin on peritoneal solute transport rate or peritoneal small solute clearance 66,67 …”

Section: Osmotic Agentmentioning

confidence: 99%

Peritoneal dialysis fluids

Low

Liew

2022

Seminars in Dialysis

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There have been significant advances in the understanding of peritoneal dialysis (PD) in the last 40 years, and uptake of PD as a modality of kidney replacement therapy is increasing worldwide. PD fluids, therefore, remains the lifeline for patients on this treatment. Developing these fluids to be efficacious in solute clearance and ultrafiltration, with minimal adverse consequences to peritoneal membrane health and systemic effects is a key requirement. Since the first PD fluid produced in 1959, modifications to PD fluids have been made. Nonetheless, the search for that ideal PD fluid remains elusive. Understanding the components of PD fluids is a key aspect of optimizing the successful delivery of PD, allowing for individualized PD prescription. Glucose remains an integral component of PD fluids; however, its deleterious effects continue to be the impetus for the search of an alternative osmotic agent, and icodextrin remains the main alternative. More biocompatible PD fluids have been developed and have shown benefits in preserving residual kidney function. However, high cost and reduced accessibility remain deterrents to its widespread clinical use in many countries. Large‐scale clinical trials are necessary and very much awaited to improve the narrow spectrum of PD fluids available for clinical use.

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A Meta-Analysis of Icodextrin versus Glucose Containing Peritoneal Dialysis in Metabolic Management of Peritoneal Dialysis Patients

Cited by 10 publications

References 23 publications

Associations between Serum-Intact Parathyroid Hormone, Serum 25-Hydroxyvitamin D. Oral Vitamin D Analogs and Metabolic Syndrome in Peritoneal Dialysis Patients: A Multi-Center Cross-Sectional Study

Associations between Serum-Intact Parathyroid Hormone, Serum 25-Hydroxyvitamin D. Oral Vitamin D Analogs and Metabolic Syndrome in Peritoneal Dialysis Patients: A Multi-Center Cross-Sectional Study

Icodextrin Versus Glucose Solutions for the Once-Daily Long Dwell in Peritoneal Dialysis: An Enriched Systematic Review and Meta-analysis of Randomized Controlled Trials

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