Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients

Abstract

Abstract. Worsening fluid balance results in reduced technique and patient survival in peritoneal dialysis. Under these conditions, the glucose polymer icodextrin is known to enhance ultrafiltration in the long dwell. A multicenter, randomized, double-blind, controlled trial was undertaken to compare icodextrin versus 2.27% glucose to establish whether icodextrin improves fluid status. Fifty patients with urine output Ͻ750 ml/d, high solute transport, and either treated hypertension or untreated BP Ͼ140/90 mmHg, or a requirement for the equivalent of all 2.27% glucose exchanges, were randomized 1:1 and evaluated at 1, 3, and 6 mo. Members of the icodextrin group lost weight, whereas the control group gained weight. Similar differences in total body water were observed, largely explained by reduced extracellular fluid volume in those receiving icodextrin, who also achieved better ultrafiltration and total sodium losses at 3 mo (P Ͻ 0.05) and had better maintenance of urine volume at 6 mo (P ϭ 0.039). In patients fulfilling the study's inclusion criteria, the use of icodextrin, when compared with 2.27% glucose, in the long exchange improves fluid removal and status in peritoneal dialysis. This effect is apparent within 1 mo of commencement and was sustained for 6 mo without harmful effects on residual renal function.

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

“…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).…”

Is Valvular Calcification a Part of the Missing Link between Residual Kidney Function and Cardiac Hypertrophy in Peritoneal Dialysis Patients?

“…The independent association between high peritoneal transport and LVMI in the multiple regression analysis suggests that reduced fluid removal secondary to high peritoneal transport may indeed be one of the factors accelerating cardiac hypertrophy in these patients. Icodextrin, which has been shown to improve volume control (33), may have a beneficial role for cardiovascular protection in PD patients. We speculated the possible link between loss of RRF, increased Ca ϫ P, inflammation, valvular calcification, and LVH in long-term PD patients in Figure 3.…”

Automated Peritoneal Dialysis Prescriptions for Enhancing Sodium and Fluid Removal: A Predictive Analysis of Optimized, Patient-Specific Dwell Times for the Day Period

“…Fourtounas et al (34) reported an average increase of 103 mmol NaR in 8 CAPD patients using icodextrin instead of 2.27% glucose solution. In a randomized controlled trial, Davies et al (35) reported an average increase of 61.7 mmol NaR and 399 mL UF during the long dwell (8 -14 hours) in a mix of CAPD and Figure 7 -The average of predicted 24-hour (A) carbohydrate (CHO) absorption and (B) ultrafiltration (UF) efficiency (UF in milliliters per gram of CHO) for each alternative therapy relative to standard therapy, for patients with high (H), high-average (HA), and low-average (LA) transport. Standard = 14-hour dwell; therapy 1 = optimized short dwell, followed by a dry day; therapy 2 = midday exchange; therapy 3 = icodextrin; therapy 4 = optimized short dwell, followed by icodextrin.…”