Effects of icodextrin in automated peritoneal dialysis on blood pressure and bioelectrical impedance analysis.
BACKGROUND
Glucose absorption from glucose-based dialysis fluids limits ultrafiltration from the daytime dwell in automated peritoneal dialysis (APD). Icodextrin may allow greater ultrafiltration during the daytime period in APD, enhancing fluid control.


METHODS
A 7.5% icodextrin dialysate was compared with a 2. 27% glucose dialysate for the daytime dwell in 14 subjects on APD. Blood pressure, weight and body water compartments estimated by multifrequency bioelectrical impedance (MFBIA) were determined in subjects using 2.27% glucose as the daytime dwell and then repeated 1 month after switching to icodextrin.


RESULTS
Icodextrin resulted in symptomatic hypotension requiring reduction of antihypertensive medication in six of the 14 patients. Despite this reduction in treatment, systolic blood pressure fell from 142.4 (23.9) mmHg to 122.9 (17.7) mmHg, P<0.005, and diastolic blood pressure tended to fall from 82.8 (9.8) mmHg to 76.8 (10.1) mmHg, P=0.075. Change in systolic blood pressure significantly correlated with changes in weight (r=0.62, P<0.05) and MFBIA estimates of total body water (TBW) (r=0.56, P<0.05), extracellular water (ECW) (r=0.79, P<0.002), extra/intracellular water ratio (ECW/ICW) (r=0.72, P<0.01) and derived resistances R(ecf) of ECW (r=-0.69, P<0.01) and R(inf) of TBW (r=-0.66, P<0.02). Changes in diastolic blood pressure significantly correlated with changes in ECW (r=0.64, P<0.02) and ECW/ICW ratio (r=0.58, P<0.05), and almost significantly with R(ecf) (r=-0.51, P=0.08) and R(inf) (r=-0.52, P=0.07) estimated by MFBIA, but not with changes in weight or TBW.


CONCLUSIONS
Use of icodextrin for the daytime dwell in APD results in improved fluid balance and blood pressure control compared with 2.27% glucose. MFBIA detected clinically important changes in fluid content in these patients.
Woodrow
G
G
Renal Unit, Leeds General Infirmary and. Centre for Bone and Body Composition Research, University of Leeds, UK.
Oldroyd
B
B
Stables
G
G
Gibson
J
J
Turney
J H
JH
Brownjohn
A M
AM
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001331:Automation; D001794:Blood Pressure / Q000187:drug effects*; D001823:Body Composition / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D015314:Dialysis Solutions / Q000032:analysis; D017097:Electric Impedance; D005260:Female; D005936:Glucans / Q000493:pharmacokinetics / Q000494:pharmacology*; D005947:Glucose / Q000493:pharmacokinetics / Q000494:pharmacology*; D006801:Humans; D000077607:Icodextrin; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D012044:Regression Analysis; D013599:Systole / Q000187:drug effects
D000959:Antihypertensive Agents; D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D005947:Glucose