A randomized multicenter clinical trial comparing isosmolar Icodextrin with hyperosmolar glucose solutions in CAPD

Mistry, Chandra D.; Gokal, Ram; Peers, Elizabeth; Brown, C B; Smith, Stephen H.; Edwards, D.L.; Junor, B. J. R.; Gordon, Alan G.; McMillan, Margaret; Robertson, Michael; Michael, J.; McKAIN, John M.; Raftery, Martin; Peters, J.; Clutterbuck, Elaine J.; Clemenger, Michelle; Walls, John; Orton, C.; Goodship, Timothy H.J.; Grieves, J.; Olubodun, J.; Jackson, F. S.; Dharmasena, D.; Hourahane, G.; Howarth, Deborah; Boyes, R.N.; Clisby, L.M.; Beran, Y.

doi:10.1038/ki.1994.300

Cited by 298 publications

(276 citation statements)

References 23 publications

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“…Icodextrin addresses one of the critical areas of vulnerability in fluid management in patients on PD: maintaining adequate UF during the long dwell. Studies that examined the relationship between patient transport status and net UF (22,23,25,27) showed that the improvements in net UF with icodextrin were greatest in patients with high and high-average membrane transport characteristics. Consistent with that observation, evidence derived from our review showed better UF in patients receiving icodextrin with high, high-average, and low-average but not low transport characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…The full-text versions of 34 studies were retrieved, 22 of which were subsequently excluded. Among other studies, 3 articles (18)(19)(20) came from the same study at different stages and another 2 articles (21,22) from 1 study were published in different journals. Finally, 9 trials published in 12 articles (18-29) with a total of 1190 participants were included in this present review, yielding 633 subjects in the icodextrin group and 557 subjects in the glucose group.…”

Section: Trial Flow and Study Characteristicsmentioning

confidence: 99%

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Comparison of Icodextrin and Glucose Solutions for Long Dwell Exchange in Peritoneal Dialysis: A Meta-Analysis of Randomized Controlled Trials

et al. 2011

Perit Dial Int

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♦ Background: Icodextrin is widely used in peritoneal dialysis (PD); however, the safety and efficacy of icodextrin are unclear. In the present study, we performed a systematic review of randomized controlled trials (RCTs) that compared icodextrin and glucose for the once-daily long dwell in PD. ♦ Methods: Electronic searches were performed in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to select all eligible studies. Eligible studies, as determined by consensus using predefined criteria, were reviewed, and data were extracted onto a standard form. ♦ Results: In the 9 RCTs that were identified, patients using icodextrin were found to have much greater net ultrafiltration (UF) and a lower incidence of negative net UF compared to patients using 1.5%, 2.5%, and 4.25% glucose solutions. Additionally, icodextrin has a markedly increased UF efficiency ratio and peritoneal clearance of creatinine and urea nitrogen, but residual renal function was not different from patients using glucose solutions for PD. No significant differences were observed between icodextrin and glucose groups with respect to risk of mortality, peritonitis, and total adverse events. Although rashes occurred significantly more often in icodextrin groups, few differences were noted between icodextrin and glucose groups when withdrawal rates secondary to adverse events were compared. ♦ Conclusions: This meta-analysis suggests that icodextrin provides patients with greater fluid removal and small solute clearance and does not cause any damage to residual renal function. Icodextrin is particularly appropriate for use in patients with high peritoneal transport status.

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Section: Discussionmentioning

confidence: 99%

Section: Trial Flow and Study Characteristicsmentioning

confidence: 99%

Comparison of Icodextrin and Glucose Solutions for Long Dwell Exchange in Peritoneal Dialysis: A Meta-Analysis of Randomized Controlled Trials

et al. 2011

Perit Dial Int

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“…Ultrafiltration with icodextrin is attributable to sustained oncotic pressure differences exerted primarily between albumin in plasma and glucose polymers in dialysate, as has been well established (1,26,29). Based on a detailed analysis of UF in APD patients (11), Venturoli et al (21) recently suggested that plasma oncotic pressure was the primary factor governing the variability of UF-versus-time curves with icodextrin.…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Residual Volume Induces Variability of Ultrafiltration with Icodextrin

2014

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♦ Background: Icodextrin induces ultrafiltration (UF) during long-dwell exchanges by creating a difference in oncotic pressure between the peritoneal cavity and plasma; however, the mechanisms governing intra-patient and inter-patient variability in UF when icodextrin is used remain largely unexplained. In the present study, we show theoretically that differences in peritoneal residual volume (V R ) have a more profound effect on UF with icodextrin use than with glucose use. This phenomenon is attributed to a differential effect of V R on oncotic, rather than osmotic, pressure between the peritoneal cavity and plasma. ♦ Methods: The three-pore model was used to calculate the effect on UF of V R between 150 mL and 1200 mL when 7.5% icodextrin (ICO) or 3.86% glucose solution is used at the end of a 12-hour dwell in the four patient transport groups (that is, fast to slow). Oncotic (with ICO) and osmotic (with glucose) pressure differences averaged over the entire dwell were also calculated. ♦ Results: As expected, at a nominal V R of 300 mL, UF with glucose differed substantially between the four patient transport groups (2 -804 mL), whereas UF with ICO did not (556 -573 mL). When V R was increased to 1200 mL from 150 mL, the concentrations of the oncotic and osmotic agents at the start of the dwell with an infusion volume of 2 L decreased to 4.9% from 7.0% with ICO and to 2.5% from 3.6% with glucose. The decrease in UF on average was greater with ICO [to 252 mL from 624 mL: that is, a reduction of 372 mL (60%)] than with glucose [to 292 mL from 398 mL: that is, a reduction of 106 mL (

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“…In addition, there has been growing concern that the hyperosmolality and low pH of these solutions may damage the peritoneum and thereby threaten its viability as a dialyzing membrane. [26] When the residual renal function declines, there may be a need for an increase in the number of the hypertonic glucose exchanges. [27] The use of peritoneal dialysis solutions not using glucose as their osmotic agent has been suggested as a strategy to reduce glucose exposure in peritoneal dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

“…Standard solutions contain different concentrations of glucose as their osmotic agents. Although these solutions have various advantages, the metabolic side effects such as hyperglycemia and hyperinsulinemia as well as a deficiency of ultrafiltration due to the rapid absorption of glucose through peritoneal membranes [14] brought newly developed peritoneal solutions into consideration.…”

Section: Introductionmentioning

confidence: 99%

Icodextrine and Insulin Resistance in Continuous Ambulatory Peritoneal Dialysis Patients

Canbakan

Sahin

2007

Renal Failure

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Insulin resistance is commonly observed in uremic patients. Glucose-based peritoneal dialysis solutions have long-term metabolic complications like hyperinsulinemia, hyperlipidemia, and obesity. The purpose of this study was to examine the insulin resistance in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) with standard glucose and icodextrin containing solutions. The entire non diabetic CAPD patients of our center were studied: forty-four patients in all who were on CAPD treatment for 36.2 ± 23.7 months. Twenty-seven of them (11 male and 16 female) with a mean age of 46 ± 16 years were treated with standard glucose solutions (glucose group). The other 17 patients (10 male and 7 female) with a mean age of 49 ± 16 years were treated with standard glucose solutions during the day and icodextrin dwell during the night, for a median of 12 ± 6.3 months (icodextrin group). Morning fasting serum insulin levels were 20.59 ± 17.86 in the glucose group and 10.15 ± 6.87 in the icodextrin group (p = 0.0001).Homeostasis Model Assessment Method scores of the glucose group were significantly higher (4.8±4.1 vs 2.3± 1.7; p = 0.025) than the icodextrin group. A significant positive correlation of HOMA score with insulin, fasting plasma glucose, and triglyceride levels were found in HOMA (IR+) patients. Twenty patients of the icodextrin group (74%) and 15 patients of the glucose group (88%) were hypertensive, but there was no statistically significant difference between the two groups (p = 0.13). The groups showed no significant differences for body mass index and serum levels of glucose, total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol, triglyceride, intact parathyroid hormone (iPTH), and fibrinogen. In conclusion, the use of icodextrin in the long nighttime dwell can reduce serum insulin levels and increase insulin sensitivity in CAPD patients.

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A randomized multicenter clinical trial comparing isosmolar Icodextrin with hyperosmolar glucose solutions in CAPD

Cited by 298 publications

References 23 publications

Comparison of Icodextrin and Glucose Solutions for Long Dwell Exchange in Peritoneal Dialysis: A Meta-Analysis of Randomized Controlled Trials

Comparison of Icodextrin and Glucose Solutions for Long Dwell Exchange in Peritoneal Dialysis: A Meta-Analysis of Randomized Controlled Trials

Peritoneal Residual Volume Induces Variability of Ultrafiltration with Icodextrin

Icodextrine and Insulin Resistance in Continuous Ambulatory Peritoneal Dialysis Patients

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