Positive Interference of Icodextrin Metabolites in Some Enzymatic Glucose Methods

Janssen, Willy; Harff, G A; Caers, Monique; Schellekens, A. P. M.

doi:10.1093/clinchem/44.11.2379

Cited by 63 publications

(39 citation statements)

References 2 publications

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“…However, there is a unique problem with icodextrin. The polymer is absorbed systemically and its metabolites can have an effect on reagent stick glucose measurements, giving rise to erroneously high blood sugar readings [9]. In all three cases discussed the overestimation of glucose by the reagent strips failed to diagnose hypoglycaemia (caused by reduced peritoneal glucose loading), with the attendant dangers to the patients.…”

Section: Discussionmentioning

confidence: 94%

Important causes of hypoglycaemia in patients with diabetes on peritoneal dialysis

et al. 2001

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Section: Discussionmentioning

confidence: 94%

Important causes of hypoglycaemia in patients with diabetes on peritoneal dialysis

et al. 2001

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“…The study carried out by Janssen et al . [6] demonstrated that both glucose oxidase and glucose dehydrogenase could have varied interference with maltose, maltotriose or maltotetrose. Therefore, it would be potentially dangerous to assume that all analysers utilizing glucose oxidase reaction are safe.…”

Section: Discussionmentioning

confidence: 99%

“…The interference of Icodextrin metabolites with different reagent strips used in blood glucose analysers has previously been described in the biochemistry and renal literature [6,7]. The clinical significance of this is the potential risk of missing the diagnosis of hypoglycaemia in both out‐patients and in‐patients using Icodextrin for CAPD.…”

Section: Introductionmentioning

confidence: 99%

Blood glucose overestimation in diabetic patients on continuous ambulatory peritoneal dialysis for end‐stage renal disease

et al. 2002

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“…Icodextrin is not metabolized in the peritoneal cavity, but the polymer could be hydrolyzed by alpha‐amylases into the blood via the lymphatic system, resulting in oligosaccharides such as maltose, maltotriose, and maltotetraose 4. The accumulation in the systemic circulation of these metabolites, especially maltose, may lead to the disparity between finger‐stick and formal blood glucose measurements 5,6…”

Section: Characteristics Of Available Glucometersmentioning

confidence: 99%

False Hyperglycemies in Diabetic Patients Using Icodextrin in Peritoneal Dialysis

Ramos

González

Fulladosa

et al. 2008

Dialysis & Transplantation

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BACKGROUND Monitoring blood glucose is an important part of integral management of peritoneal dialysis (PD) patients with diabetes. Nowadays, several systems of glucometers are commercially available, and practically all are based on 3 enzymatic reactions. The two systems used most often are glucose oxidase (GOD) and glucose dehydrogenase using pyrroloquinolinequinone cofactor (GDH/PQQ). On the other hand, icodextrin (Extraneal) is an isosmotic PD solution containing glucose polymers. Accumulation in the systemic circulation of icodextrin metabolites may lead to a disparity between fi nger‐stick and formal blood glucose measurement. METHODS We analyzed the possible interference of icodextrin metabolites with various glucose assays in 9 diabetic patients undergoing PD using icodextrin. RESULTS The simple regression test showed a good association between central laboratory values and the Ascensia Breeze II (Bayer) glucometer:GOD (r = 0.928; p < 0.0001), the One Touch Ultra (Johnson and Johnson): GOD (r = 0.911; p < 0.0002), and the Glucocard Memory 2 (Menarini):GOD (r = 0.966; p < 0.00001). Nevertheless, the Accu‐chek Aviva (Roche):GDH/PQQ showed poor correlation (r = 0.353; p = 0.317) with the laboratory results. It has been suggested that maltose interferes with glucose assays that use glucose dehydrogenase with GDH/PQQ, leading to falsely increased readings. Our results confirmed that GDH/PQQ devices overestimated glucose levels in these patients CONCLUSIONS We concluded that patients with diabetes mellitus treated by icodextrin‐PD are at risk of having erroneous blood glucose measurements using GDH/PQQ‐based glucometers. Careful attention needs to be given to checking that the glucose devices used in these patients are based on GOD, GDH with a different PQQ cofactor, or hexokinase methods in order to minimize the risk of hypoglycemies due to an overdose of insulin.

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Positive Interference of Icodextrin Metabolites in Some Enzymatic Glucose Methods

Cited by 63 publications

References 2 publications

Important causes of hypoglycaemia in patients with diabetes on peritoneal dialysis

Important causes of hypoglycaemia in patients with diabetes on peritoneal dialysis

Blood glucose overestimation in diabetic patients on continuous ambulatory peritoneal dialysis for end‐stage renal disease

False Hyperglycemies in Diabetic Patients Using Icodextrin in Peritoneal Dialysis

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