Icodextrin is Associated with a Lower Mortality Rate in Peritoneal Dialysis Patients

Abstract

Background Icodextrin (ICO) improves fluid removal in peritoneal dialysis (PD) patients. However, whether physiological benefits of ICO translate into patient survival remains unclear. We examine the association of ICO and clinical outcomes. Methods We identified patients who initiated long-term PD from the National Health Insurance Research Database of Taiwan. We matched ICO users with non-users according to propensity score and survival status when ICO was prescribed. We utilized time-dependent analyses to avoid immortal time bias. Additional competing risk models were utilized for the outcomes except for death. The outcomes of interest were time to death, technique failure, peritonitis, major adverse cardiovascular events (MACE), and hospitalization. Results A total of 4,914 PD patients were enrolled and 2,836 PD patients (57.7%) were identified as ICO users. The ICO users had significantly better overall survival (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.63 – 0.86), especially among early ICO users (HR 0.64; 95% CI 0.54 – 0.77, p value for interaction: 0.007). The ICO users were associated with higher risk of peritonitis (subdistribution HR 1.22, 95% CI 1.06 – 1.14) and hospitalization (subdistribution HR 1.14, 95% CI 1.05 – 1.24), considering competing risk of death. However, when considering ICO use as a time-varying covariate, ICO users shared similar risks for technique failure, peritonitis, MACE, and hospitalization as non-users. The effect of ICO on mortality was especially prominent among those early users. Conclusions After adjustments for immortal time biases, ICO users were significantly associated with approximately 20% reduction in mortality, especially among early users.

Icodextrin Versus Glucose Solutions for the Once-Daily Long Dwell in Peritoneal Dialysis: An Enriched Systematic Review and Meta-analysis of Randomized Controlled Trials

“…The findings concerning mortality risk are consistent with observational data. [114][115][116][117][118][119][120][121][122] The review highlights differential benefit in high/high-average transport patients, a subgroup with particularly high mortality risk. [34][35][36] This finding is again consistent with observational data.…”

Home Versus Facility Dialysis and Mortality in Australia and New Zealand

“…This intervention probably decreases mortality risk in clinical trials. [59][60][61][62] Although differences in survival according to subgroups were not among our a priori objectives, in the exploratory analyses we noted that the mortality rates of elderly and diabetic patients on PD were similar to those of HD patients. Once again, this finding must be regarded in the light of possible selection bias from imbalance of unmeasured confounders as described previously.…”

How to Improve the Biocompatibility of Peritoneal Dialysis Solutions (without Jeopardizing the Patient’s Health)

“…Indeed, the use of icodextrin-containing solutions in chronic heart failure patients who were refractory to conservative treatment proved to be a viable option leading to a better cardiac functional status, and lowered the number of hospital admissions [ 81 , 82 ]. Some studies have also shown that long-term utilization of icodextrin solution in ESKF may extend patient survival and PD viability [ 83 , 84 ].…”