Single Daily Icodextrin Exchange as Initial and Solitary Therapy

Agar, Baris U.; Sloand, James A.

doi:10.3747/pdi.2017.00130

Cited by 7 publications

(10 citation statements)

References 35 publications

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“…Our data also showed that an early ICO prescription had no detrimental effects (and had even some advantages), at least in a targeted population (Table 3). The beneficial effect on earlier ICO users supports the proposition of a solitary ICO exchange to initiate an incremental therapy for some incident dialysis patients (32).…”

Section: Icodextrin and Mortalitymentioning

confidence: 67%

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

et al. 2019

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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.

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Section: Icodextrin and Mortalitymentioning

confidence: 67%

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

et al. 2019

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“…Other popular incremental CAPD prescriptions include icodextrin dwells, typically of 8 to 12 h duration, done once or twice daily (Table 2). 15,16…”

Section: Defining Incremental Pdmentioning

confidence: 99%

“…10 Multiple other uncontrolled studies, including descriptions of outcomes in Hong Kong with routine three 2-l dwells daily report good outcomes with incremental PD. 15,16,33 –36 In all this literature, the nature of incremental PD varies with most using incremental CAPD, but others vary using incremental APD.…”

Section: What Is the Evidence?mentioning

confidence: 99%

Incremental peritoneal dialysis

2020

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Incremental peritoneal dialysis (PD) has been variably defined. It involves taking advantage of the residual renal function that is usually present at initiation of dialysis to initially prescribe less onerous lower doses of PD while still achieving individualized clearance goals. We propose that incremental PD be defined as a strategy, rather than a particular regime, in which: (1) less than standard “full-dose” PD is initially prescribed in recognition of the value of residual renal function; (2) peritoneal clearance is initially less than the individualized clearance goal but the combination of peritoneal plus renal clearance achieves or exceeds that goal clearance; and (3) there is a clear intention to increase dose of PD as renal clearance declines and/or symptoms appear. Incremental PD by its nature lessens the workload of dialysis for those doing PD, reduces cost and exposure of the peritoneal membrane to glucose, and may lessen mechanical symptoms. Evidence that incremental PD improves clinical outcomes compared to the use of full-dose PD is lacking but one randomized controlled trial, multiple observational studies, and a systematic review all suggest that outcomes are at least as good. Given that incremental PD costs less and is inherently less onerous, it is reasonable, pending larger randomized trials, to adopt this strategy.

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“…Moreover, due to it being a glucose polymer with minimal absorption, sustained colloid osmotic gradient results in maximal convective SR during long dwells making it an appealing option for single use in a subset of patients with HF and CRS for whom clearance might not be the primary concern. In a recent simulation study, single daily icodextrin exchanges of 8–16 h resulted in SR of up to 87 mmol [11]. In an HF patient with low-sodium intake (e.g., 100 mmol/day), this would readily translate into a desirable negative daily sodium balance.…”

Section: Icodextrinmentioning

confidence: 99%

“…Larger dialysate volumes can recruit more peritoneal membrane (i.e., “wetted” membrane) and result in further enhancement of SR by virtue of involving higher number of small pores in the exchange process [11]. However, it should be noted that progressively higher intraperitoneal pressures induced by larger dialysate volumes (i.e., > 1,400 mL/m 2 body surface area) could hamper or offset this salutary effect at some point by facilitating back-ultrafiltration and back-diffusion of sodium [24].…”

Section: Peritoneal Dialysate Volumementioning

confidence: 99%

Customization of Peritoneal Dialysis in Cardiorenal Syndrome by Optimization of Sodium Extraction

2019

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Background: Peritoneal dialysis (PD) has emerged as a mechanistically relevant therapeutic option for patients with heart failure (HF), volume overload, and varying degrees of renal dysfunction (i.e., chronic cardiorenal syndrome). Congestion has been identified as a potent ominous prognostic factor in this patient population, outperforming a number of established risk factors. As such, excess fluid removal is recognized as a relevant therapeutic target in this setting. Methods: Accumulating evidence points to the importance of sodium removal as part of any decongestive strategy because extraction of sodium-free water has little or no impact on the outcomes of these patients. Hence, optimization of sodium removal by PD should be the primary focus in the setting of HF and cardiorenal syndrome, especially if PD is started when the patient still has adequate residual renal function for clearance of waste products. Results: Herein, we provide an overview of approaches that can tailor PD treatment to the patients’ characteristics and clinical needs (e.g., choice of PD modality) to fully exploit its decongestive properties. Other methods that could prove helpful in the future will also be briefly discussed. Conclusion: While these strategies could help with efficient sodium extraction and volume optimization, future studies are needed to evaluate their impact on the outcomes of this specific patient population.

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Single Daily Icodextrin Exchange as Initial and Solitary Therapy

Abstract: A single daily icodextrin exchange can be tailored to augment urea, UF, and Na removal in patients with sufficient residual kidney function (RKF). A solitary icodextrin exchange may therefore be reasonable initial therapy for some incident ESRD patients.

Cited by 7 publications

References 35 publications

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

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

Incremental peritoneal dialysis

Customization of Peritoneal Dialysis in Cardiorenal Syndrome by Optimization of Sodium Extraction

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