title: Comparison of icodextrin and glucose solutions for the daytime dwell in automated peritoneal dialysis.
abstract: BACKGROUND
  The sustained ultrafiltration achieved by icodextrin is more suited for the daytime dwell in automated peritoneal dialysis (APD) than glucose solutions.
  
  
  METHODS
  Seventeen patients receiving APD underwent assessment using three different solutions for the daytime dwell: 2.27% glucose, 3.86% glucose and 7.5% icodextrin. Patients were then observed on icodextrin for a 6 month period.
  
  
  RESULTS
  Daytime ultrafiltration was greater for 3.86% glucose (median 0.10, IQR 0.01 to 0.321) P<0.01 and icodextrin (median 0.26, IQR 0.14 to 0.361) P<0.001 than 2.27% glucose (median -0.19, IQR -0.54 to -0.081), with 3.86% glucose and icodextrin not being significantly different. Positive ultrafiltration occurred in 3/17 patients with 2.27% glucose, 13/17 patients with 3.86% glucose and 16/17 patients with icodextrin (chi2 P<0.0001). The difference in ultrafiltration of icodextrin and 3.86% glucose correlated with the 4 h dialysate/plasma creatinine ratio in a PET test (r = 0.51, P<0.05). Daytime Kt/V urea was greater for 3.86% glucose (median 0.27, IQR 0.20 to 0.48 per week, P<0.01) and icodextrin (median 0.31, IQR 0.27 to 0.49 per week, P<0.0001) than for 2.27% glucose (median 0.22, IQR 0.15 to 0.38 per week), with the difference between 3.86% glucose and icodextrin not reaching statistical significance (P = 0.06). Daytime creatinine clearance was greater for 3.86% glucose (median 10.2, IQR 6.9 to 13.61/week/1.73 m2, P<0.02) and icodextrin (median 12.1, IQR 9.3 to 15.71/week/1.73 m2, P<0.005) than for 2.27% glucose (median 8.8, IQR 4.9 to 11.91/week/1.73 m2). Daytime creatinine clearance was greater for icodextrin than for 3.86% glucose (P<0.005). The effects of icodextrin were sustained for the 6 month observation period.
  
  
  CONCLUSIONS
  Icodextrin produced enhanced ultrafiltration and clearances compared with 2.27% glucose, without the exposure of the peritoneum to hypertonic glucose solutions.
authors.affiliation: Renal Unit, Leeds General Infirmary, UK.
authors.forename: G
authors.initials: G
authors.lastname: Woodrow
authors.forename: G
authors.initials: G
authors.lastname: Stables
authors.forename: B
authors.initials: B
authors.lastname: Oldroyd
authors.forename: J
authors.initials: J
authors.lastname: Gibson
authors.forename: J H
authors.initials: JH
authors.lastname: Turney
authors.forename: A M
authors.initials: AM
authors.lastname: Brownjohn
mesh_terms: D000328:Adult; D000368:Aged; D015314:Dialysis Solutions / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D005936:Glucans / Q000494:pharmacology*; D005947:Glucose / Q000494:pharmacology*; D006801:Humans; D000077607:Icodextrin; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D010530:Peritoneal Dialysis; D014462:Ultrafiltration; D014508:Urea / Q000378:metabolism
chemical_list: D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D014508:Urea; D005947:Glucose