Randomized controlled study of icodextrin on the treatment of peritoneal dialysis patients during acute peritonitis

Chow, Kai Ming; Szeto, Cheuk‐Chun; Kwan, Bonnie Ching‐Ha; Pang, Wing Fai; Ma, Ting; Leung, Chi Bon; Law, Man Ching; Li, Philip Kam-Tao

doi:10.1093/ndt/gfu033

Cited by 24 publications

(14 citation statements)

References 13 publications

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“…Temporary use of hypertonic exchanges and short dwell times may be needed to maintain adequate fluid removal. Temporary use of icodextrin solution may prevent fluid overload in PD patients with acute peritonitis ( 342 ). Because of rapid glucose absorption, glycemic control may worsen in diabetic patients.…”

Section: Initial Presentation and Management Of Peritonitismentioning

confidence: 99%

ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment

et al. 2016

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Section: Initial Presentation and Management Of Peritonitismentioning

confidence: 99%

ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment

et al. 2016

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“…PD patients tended to suffer from fluid overload during acute peritonitis because of ultrafiltration decline; thus, they may need more hypertonic glucose dialysate to facilitate fluid removal. Indeed, a recent clinical trial from Hong Kong demonstrated more than 30% of CAPD patients may require additional dialysate exchanges to achieve fluid balance during the course of peritonitis [27]. In this study, there were 28 (15.0%) patients who had to increase PD dose or use solution with higher glucose concentration because of acute ultrafiltration decline.…”

Section: Discussionmentioning

confidence: 90%

“…In addition, diuretic is effective in increasing urine output. Glucose-sparing solution icodextrin shows strengths in fluid removing during acute peritonitis versus conventional glucose-based solution, and thus, it is strongly recommended [27]. …”

Section: Discussionmentioning

confidence: 99%

High Peritoneal Glucose Exposure Is Associated with Increased Incidence of Relapsing and Recurrent Bacterial Peritonitis in Patients Undergoing Peritoneal Dialysis

Jiang

Zhang²,

Fang³

et al. 2015

Blood Purif

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Aim: We investigated the association of peritoneal glucose exposure and dialysis exchange number with peritonitis outcome in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods: The first episodes of bacterial peritonitis were retrospectively analyzed in 187 CAPD patients. Peritoneal glucose exposure was calculated based on PD prescription at the onset of peritonitis. Results: Patients with peritoneal glucose exposure ≤140 g/day showed a higher and complete cure rate of peritonitis (66 vs. 51.7%, p = 0.047), lower occurrence of relapsing/recurrent peritonitis (10.0 vs. 21.8%, p = 0.026) and catheter removal (14.0 vs. 26.4%, p = 0.033). Patients who exchanged more than three times every day demonstrated marginally higher catheter removal rate (24.1 vs. 13.0%, p = 0.085). Logistic analysis indicated that peritoneal glucose exposure >140 g/day was an independent predictor for relapsing/recurrent peritonitis (RR: 1.959, p = 0.042). Conclusion: High peritoneal glucose exposure is associated with increased incidence of relapsing/recurrent peritonitis in CAPD patients.

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“…Most trials explicitly excluded patients with acute peritonitis, but one focused specifically on such patients. 84 One study included solely patients with hypertension related to volume overload. 85 Baseline patient characteristics are detailed in Table S4.…”

Section: Trial and Patient Characteristicsmentioning

confidence: 99%

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

Goossen

Becker

Marshall

et al. 2020

American Journal of Kidney Diseases

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The efficacy and safety of icodextrin versus glucose-only peritoneal dialysis (PD) regimens is unclear. The aim of this study was to compare once-daily long-dwell icodextrin versus glucose among patients with kidney failure undergoing PD. Study Design: Systematic review of randomized controlled trials (RCTs), enriched with unpublished data from investigator-initiated and industry-sponsored studies. Setting & Study Populations: Individuals with kidney failure receiving regular PD treatment enrolled in clinical trials of dialysate composition. Selection Criteria for Studies: Medline, Embase, CENTRAL, Ichushi Web, 10 Chinese databases, clinical trials registries, conference proceedings, and citation lists from inception to November 2018. Further data were obtained from principal investigators and industry clinical study reports. Data Extraction: 2 independent reviewers selected studies and extracted data using a prespecified extraction instrument. Analytic Approach: Qualitative synthesis of demographics, measurement scales, and outcomes. Quantitative synthesis with Mantel-Haenszel risk ratios (RRs), Peto odds ratios (ORs), or (standardized) mean differences (MDs). Risk of bias of included studies at the outcome level was assessed using the Cochrane risk-of-bias tool for RCTs. Results: 19 RCTs that enrolled 1,693 participants were meta-analyzed. Ultrafiltration was improved with icodextrin (medium-term MD, 208.92 [95% CI, 99.69-318.14] mL/24 h; high certainty of evidence), reflected also by fewer episodes of fluid overload (RR, 0.43 [95% CI, 0.24-0.78]; high certainty). Icodextrin-containing PD probably decreased mortality risk compared to glucose-only PD (Peto OR, 0.49 [95% CI, 0.24-1.00]; moderate certainty). Despite evidence of lower peritoneal glucose absorption with icodextrin-containing PD (medium-term MD, −40.84 [95% CI, −48.09 to −33.59] g/ long dwell; high certainty), this did not directly translate to changes in fasting plasma glucose (−0.50 [95% CI, −1.19 to 0.18] mmol/L; low certainty) and hemoglobin A 1c levels (−0.14% [95% CI, −0.34% to 0.05%]; high certainty). Safety outcomes and residual kidney function were similar in both groups; health-related quality-of-life and pain scores were inconclusive. Limitations: Trial quality was variable. The followup period was heterogeneous, with a paucity of assessments over the long term. Mortality results are based on just 32 events and were not corroborated using time-to-event analysis of individual patient data. Conclusions: Icodextrin for once-daily long-dwell PD has clinical benefit for some patients, including those not meeting ultrafiltration targets and at risk for fluid overload. Future research into patient-centered outcomes and costeffectiveness associated with icodextrin is needed. T he prevalence of kidney replacement therapy is expected to increase steeply. 1 Approximately 15% of dialysis patients globally use peritoneal dialysis (PD), and this proportion is increasing. 2 PD is probably associated with the same survival as hemodialysis (HD) 3-6 but pre...

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Randomized controlled study of icodextrin on the treatment of peritoneal dialysis patients during acute peritonitis

Cited by 24 publications

References 13 publications

ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment

ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment

High Peritoneal Glucose Exposure Is Associated with Increased Incidence of Relapsing and Recurrent Bacterial Peritonitis in Patients Undergoing Peritoneal Dialysis

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

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