Peritoneal kinetics and mesothelial markers in CCPD using icodextrin for daytime dwell for two years.
OBJECTIVE
To evaluate the safety, efficacy, and biocompatibility of icodextrin (Ico), continuous cycling peritoneal dialysis (CCPD) patients were treated for 2 years with either Ico- or glucose (Glu)-containing dialysis fluid for their daytime dwell (14 - 15 hours). Prior to entry into the study, all patients used standard Glu solutions (Dianeal, Baxter BV, Utrecht,The Netherlands).


METHODS
Open, randomized, prospective two-center study.


METHODS
University hospital and teaching hospital.


METHODS
Both established patients and patients new to CCPD were included. A life expectancy of more than 2 years, a stable clinical condition, and written informed consent were necessary before entry. Patients aged under 18 years or with peritonitis in the previous month, and women of childbearing potential unless taking adequate contraceptive precautions, were excluded. Thirty-eight patients entered the study (19 Glu, 19 Ico).


METHODS
Daytime dwell peritoneal effluents were collected every 3 months in combination with other study variables (clinical data, laboratory measurements, dialysis-related data, and urine collection). Peritoneal transport studies were carried out every 6 months.


RESULTS
In Glu- and Ico-treated patients, peritoneal transport of low molecular weight solutes and protein clearances neither changed during follow-up nor differed between the two groups. Peritoneal membrane markers (CA125, interleukin-8, carboxyterminal propeptide of type I procollagen, and aminoterminal propeptide of type III procollagen) measured in effluents did not differ between the groups and did not change over time. All these markers showed a dialysate/plasma ratio of more than 1, suggesting local production. Residual renal function remained stable during follow-up and adverse clinical effects were not observed.


CONCLUSIONS
Peritoneal membrane transport kinetics and markers remained stable in both groups over a 2-year follow-up period. Membrane markers were higher in effluents than in serum, suggesting local production. No clinical side effects were demonstrated. Icodextrin was a well-tolerated effective treatment.
Posthuma
N
N
Department of Nephrology, Free University Hospital, Amsterdam, The Netherlands. nefrol@AZVU.nl
Verbrugh
H A
HA
Donker
A J
AJ
van Dorp
W
W
Dekker
H A
HA
Peers
E M
EM
Oe
P L
PL
ter Wee
P M
PM
D000328:Adult; D000368:Aged; D004848:Epithelium; D005260:Female; D005936:Glucans / Q000493:pharmacokinetics*; D005947:Glucose / Q000493:pharmacokinetics*; D015312:Hemodialysis Solutions / Q000493:pharmacokinetics*; D006801:Humans; D000077607:Icodextrin; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011446:Prospective Studies; D013997:Time Factors; D014462:Ultrafiltration
D005936:Glucans; D015312:Hemodialysis Solutions; D000077607:Icodextrin; D005947:Glucose