Effect of icodextrin on volume status, blood pressure and echocardiographic parameters: A randomized study

Abstract

Overhydration is a risk factor for hypertension and left ventricular hypertrophy in peritoneal dialysis patients. Recently, a high prevalence of subclinical overhydration was observed in peritoneal dialysis patients. Aim of the present open-label randomized study was to assess the effect of a icodextrin 7.5% solution on fluid status [extracellular water (ECW) bromide dilution], blood pressure regulation (24-hour ambulatory measurements) and echocardiographic parameters during a study period of 4 months, and to relate the effect to peritoneal membrane characteristics (dialysate/plasma creatinine ratio). Forty peritoneal dialysis patients (22 treated with icodextrin, 18 controls) were randomized to either treatment with icodextrin during the long dwell or standard glucose solutions. Thirty-two patients (19 treated with icodextrin, 13 controls] completed the study. The use of icodextrin resulted in a significant increase in daily ultrafiltration volume (744 +/- 767 mL vs. 1670 +/- 1038 mL; P = 0.012) and a decrease in ECW (17.5 +/- 5.2 L vs. 15.8 +/- 3.8 L; P = 0.035). Also the change in ECW between controls and patients treated with icodextrin was significant (-1.7 +/- 3.3 L vs. +0.9 +/- 2.2 L; P = 0.013). The effect of icodextrin on ECW was not related to peritoneal membrane characteristics, but significantly related to the fluid state of the patients (ECW:height) (r = -0.72; P < 0.0001). Left ventricular mass (LVM) decreased significantly in the icodextrin-treated group (241 +/- 53 grams vs. 228 +/- 42 grams; P = 0.03), but not in the control group. In this randomized open-label study, the use of icodextrin resulted in a significant reduction in ECW and LVM. The effect of icodextrin on ECW was not related to peritoneal membrane characteristics, but was related to the initial fluid state of the patient.

Residual Urinary Volume Is a Predictor of Overhydration in Patients on Peritoneal Dialysis

“…Their study suggests that hypervolumic status per se is not protective of long-term preservation of residual renal function. On the contrary, Konings et al (2003) showed that patients with a reduction in extracellular volumes associated with icodextrin have a faster decrease in their UO and residual renal function. However, in their study, the patients were euvolemic, and the baseline levels of residual renal function were substantially higher than those in the study of Davies et al (2003).…”

“…Diabetic patients have also increased thirst (Davies 2003). The higher blood sugar levels in diabetic patients could lead to reduced net ultrafiltration by reducing the peritoneal to blood glucose osmotic gradient, with consequent increased reliance on PD solutions with higher glucose content (Konings et al 2003). Restricting salt and water intake may help reduce the use of hypertonic glucose solution and thus facilitate blood glucose control in diabetic patients undergoing PD (Watson et al 1980).…”

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

“…On the other hand, this would suggest that icodextrin has a relative protective effect in preserving urine volume when UF is increased. An alternative explanation might be that the extracellular fluid compartment contracted due to a reduction in the interstitial rather than the intravascular space (25). But this dramatic change in fluid removal caused fluid depletion and subsequent hypotension (26) in the patients with reduction in urine volume and residual renal function.…”

“…It is becoming increasingly clear that one of the primary responsibilities of clinicians in the management of PD patients is the balance between adequate control of fluid status and preservation of residual renal function. Numerous clinical studies (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(35)(36)(37) and more than 9 years of post-marketing surveillance have confirmed that icodextrin is a safe and well-tolerated osmotic alternative PD solution to glucose. The most significant adverse effect reported to date is a cutaneous hypersensitivity reaction (38,39).…”

Hyponatremia and Hypokalemia in Peritoneal Dialysis Patients

“…The residual renal function tended to be higher at 12 months in hyponatremic group. Excessive peritoneal ultrafiltration may, by provoking intravascular volume depletion, play a causative role in the decline in residual renal function (Konings et al, 2005;Konings et al, 2003). In the present study, it is possible that increased D/P Cr and, consequently, lower peritoneal ultrafiltration volume in the hyponatremic group might provide a lower risk of intravascular volume depletion and higher probability of relative increase of residual renal function.…”