Aseptic peritonitis: role of icodextrin

Montagnac, R; Slingeneyer, A; Schillinger, F

doi:10.1093/ndt/16.2.435

Cited by 10 publications

(4 citation statements)

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“…These cases, in which peritonitis appeared after the first contact with icodextrin, are compatible with an acute icodextrin-induced chemical peritonitis. Montagnac et al reported a possible case of icodextrin-related sterile peritonitis in a patient on long-term icodextrin therapy (12), but interpretation of this case is difficult because extensive intra-abdominal pathology was present in the patient described in this report. More recently, Heering et al (13) and Reichel et al (14) each reported a case of culture-negative peritonitis in patients several months on icodextrin.…”

Section: Discussionmentioning

confidence: 77%

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Culture-Negative Peritonitis Associated with the use of Icodextrin-Containing Dialysate in Twelve Patients Treated with Peritoneal Dialysis

2003

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← Background In the first half of the year 2001, an unusually large number of culture-negative peritonitis episodes occurred in Center A. One patient noticed that his culture-negative antibiotic-resistant peritonitis promptly cleared after inadvertently stopping the use of icodextrin-containing dialysate, but recurred immediately after using icodextrin again. This observation led to the recognition of eight contemporaneous cases of icodextrin-induced culture-negative peritonitis in Center A, and identification of three additional cases in Center B. ← Design Case studies in 12 patients. ← Setting Peritoneal dialysis unit of a university hospital and an affiliated unit (Center A), and a second university hospital (Center B). ← Patients 12 patients on peritoneal dialysis presenting with culture-negative peritonitis. ← Results At presentation, abdominal pain was absent or mild and dialysate leukocyte counts were moderately elevated (approximately 100 – 1500 cells/mm3). Differentiation of the dialysate leukocytes showed a low fraction of neutrophils (approximately 35%). In eight cases, the evidence that the peritonitis was caused by icodextrin was very strong (the clinical picture and laboratory results mentioned above, unresponsiveness to antibiotic therapy, cure after withdrawal of icodextrin, relapse after rechallenge); in 3 patients, the evidence was strong (as in the cases mentioned above, but no rechallenge was performed). Stopping icodextrin promptly relieved the symptoms and normalized the dialysate leukocyte counts. After rechallenge, a relapse invariably occurred, usually within a few days. In one case, the evidence was circumstantial. ← Conclusion Our findings are compatible with icodextrin-induced peritonitis. This entity is characterized by mild abdominal pain at presentation, a moderate dialysate leukocytosis with a low fraction of neutrophils in the differential count, and resistance to antibiotic treatment. Speculations about the pathogenesis of this type of peritonitis include chemical peritonitis due to a contaminating substance or hypersensitivity to icodextrin.

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Section: Discussionmentioning

confidence: 77%

“…Montagnac etal. reported a possible case of icodextrin-related sterile peritonitis in a patient on long-term icodextrin therapy (12), but interpretation of this case is difficult because extensive intra-abdominal pathology was present in the patient described in this report. More recently, Heering etal.…”

Section: Discussionmentioning

confidence: 81%

Culture-Negative Peritonitis Associated with the use of Icodextrin-Containing Dialysate in Twelve Patients Treated with Peritoneal Dialysis

2003

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“…Episodes of sterile peritonitis have also been reported that were caused by endotoxin contamination of the dialysis solution, intraperitoneal chemical agents (including glucose degradation products and several drugs), allergic mechanisms (including eosinophilic peritonitis) or, rarely, by peritoneal metastases, pancreatitis and abdominal lymphomas [ 29–34 ]. Between November 2001 and July 2002, a markedly increased incidence of sterile peritonitis associated with icodextrin treatment was reported [ 35–41 ]. These cases were caused by a peptidoglycan (released from Alicyclobacillus acidocaldarius, a thermophilic acidophilic Gram-positive organism contaminating the cornstarch used for icodextrin production) [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Icodextrin does not impact infectious and culture-negative peritonitis rates in peritoneal dialysis patients: a 2-year multicentre, comparative, prospective cohort study

Vychytil

Remón

Michel

et al. 2008

Nephrology Dialysis Transplantation

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Background. Icodextrin is a glucose polymer derived by hydrolysis of cornstarch. The different biocompatibility profile of icodextrin-containing peritoneal dialysis (PD) solutions may have a positive influence on peritoneal host defence. Furthermore, cases of sterile peritonitis potentially associated with icodextrin have been reported.Methods. The primary objective of this multicentre, longitudinal, observational, non-interventional, prospective cohort study, which included 722 PD patients, was to evaluate the incidence of overall peritonitis in patients treated with icodextrin-containing PD solutions (Extraneal™) used during one long-dwell exchange/day compared with those treated with non-icodextrin-containing PD solutions. The secondary objective was to determine if culture-negative peritonitis rates differed between patients treated with icodextrin from two independent manufacturers. All peritonitis episodes were assessed by a Steering Committee in a blind manner.Results. There was no significant difference between icodextrin-treated and control patients in the adjusted overall, culture-positive or culture-negative peritonitis rates. When stratified by the icodextrin supplier, there was no significant difference in the adjusted rate of culture-negative peritonitis episodes between groups.Conclusion. Subjects receiving icodextrin as part of their PD regimen experienced neither a higher rate of culture-negative peritonitis nor a lower rate of infectious peritonitis compared with non-icodextrin users. There was no significant influence of the icodextrin raw material supplier on peritonitis rates.

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“…However, it is well known that icodextrin can cause allergic cutaneous manifestations [97,98] and sterile peritonitis [99][100][101][102][103][104].…”

Section: Glucose Polymer Solutionmentioning

confidence: 99%

Volume Control in Peritoneal Dialysis Patients: Role of New Dialysis Solutions

Lameire¹

2004

Blood Purif

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This paper reviews the most recent clinical data on the volume status of long-term peritoneal dialysis (PD) patients. It appears that many PD patients are volume overloaded, associated with a high prevalence of hypertension and left ventricular hypertrophy. In the presence of the poor results in patients with peritoneal ultrafiltration, the introduction of the polyglucose solution, icodextrin, has ameliorated volume control in some of these patients. In a second part of the review, some of the structural and functional alterations in the peritoneal membrane and the role of glucose degradation products (GDP) in the commonly used dialysates as well as the resulting formation of advanced glycation end products are described. The introduction of low GDP-containing solutions at normal pH has at least in experimental models of PD attenuated the hemodynamic changes observed with the classical solutions. The solutions at normal pH containing either bicarbonate or a mixture of bicarbonate/lactate were clinically associated with less inflow pain.

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Aseptic peritonitis: role of icodextrin

Cited by 10 publications

References 0 publications

Culture-Negative Peritonitis Associated with the use of Icodextrin-Containing Dialysate in Twelve Patients Treated with Peritoneal Dialysis

Culture-Negative Peritonitis Associated with the use of Icodextrin-Containing Dialysate in Twelve Patients Treated with Peritoneal Dialysis

Icodextrin does not impact infectious and culture-negative peritonitis rates in peritoneal dialysis patients: a 2-year multicentre, comparative, prospective cohort study

Volume Control in Peritoneal Dialysis Patients: Role of New Dialysis Solutions

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