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

Abstract

♦ 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.

ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I – Assessment and Management of Various Cardiovascular Risk Factors

“…There are no randomized controlled trials of smoking vs non-smoking, but since there is over whelming evidence in the general population to suggest that smoking is harmful, it is unlikely that there ever will be a randomized controlled trial in PD patients. RATIONALE: In 3 recent meta-analyses, an increase in peritoneal ultrafiltration volume as well as a reduction in episodes of uncontrolled fluid overload were observed with the use of icodextrin compared with conventional glucose PD solutions (27)(28)(29)30). The effect of icodextrin was most pronounced in patients with high/high-average transport state.…”

Stability of the Combination of Ceftazidime and Cephazolin in Icodextrin or PH Neutral Peritoneal Dialysis Solution

“…Extraneal PD solution contains icodextrin (a polymer with an average molecular weight of 17,000 Da) as a colloid osmotic agent. Because of its large molecular weight, icodextrin is absorbed less into the systemic circulation and hence, less likely to cause systemic side effects (4). It has been reported that the long-term exposure to a pH neutral Balance PD solution causes less peritoneal inflammation and has a minimal effect on vasoregulation (5)(6).…”

Purple Icodextrin: Turkish Delight?

“…In several studies, a tight association has been observed between elevated serum phosphorus and mortality (1,2).…”

“…It is used by more than 10 000 peritoneal dialysis (PD) patients worldwide because it provides sustained positive net ultrafiltration during the long dwell and better metabolic control than that provided by glucose-based solutions, especially in diabetic PD patients (1,2). Furthermore, positive associations with patient and technique survival have been demonstrated for icodextrin (3).…”