Effects of peritoneal dialysis with an overnight icodextrin dwell on parameters of glucose and lipid metabolism.
OBJECTIVE
To examine whether a reduced daily glucose load by overnight application of the less-absorbed glucose polymer icodextrin would have favorable effects on lipid profiles of continuous ambulatory peritoneal dialysis (CAPD) patients.


METHODS
Randomized crossover study with two subsequent periods of 6 weeks.


METHODS
Home PD unit of a secondary-care hospital.


METHODS
Twenty-one nondiabetic CAPD patients (15 male, 6 female; mean age 50.3+/-11.8 years).


METHODS
Participants were randomly assigned to receive an overnight dwell with either standard glucose solution or with a 7.5% icodextrin-containing solution.


METHODS
Relation between reduction in the total amount of intraperitoneal infused glucose and parameters of glucose (plasma glucose, insulin, and HbA1C) and lipid metabolism [free fatty acids, plasma lipids, lipoproteins, and low density lipoprotein (LDL) subfraction profile].


RESULTS
After the icodextrin dwells, a reduction of plasma total cholesterol (from 5.43+/-0.85 to 4.86+/-0.70 mmol/L, p < 0.001) and LDL cholesterol (from 3.38+/-0.87 to 2.93+/-0.73 mmol/L, p = 0.001) was observed. Also, high density lipoprotein (HDL) cholesterol (from 0.95+/-0.27 to 0.90+/-0.24 mmol/L, p = 0.029) was reduced, but the plasma total cholesterol-to-HDL ratio remained similar. Plasma free fatty acids and triglyceride levels tended to decrease (from 0.16+/-0.10 to 0.13+/-0.08 mmol/L, p= 0.06, and from 2.14+/-1.96 to 1.92+/-1.03 mmol/L, respectively). Evaluation of LDL subfraction profiles after ultracentrifugation showed a more buoyant LDL subfraction profile with fewer dense LDL particles in 6 patients and no changes in 14 patients after icodextrin. The effects on lipids were not accompanied by a decrease in fasting plasma glucose (from 5.76+/-1.29 to 5.86+/-0.80 mmol/L) or insulin levels (from 19.5+/-14.4 to 20.3+/-13.0 mU/L).


CONCLUSIONS
These results suggest a beneficial effect on lipid profiles of CAPD patients with the use of an overnight dwell with icodextrin.
Bredie
S J
SJ
Department of Medicine, University Medical Centre of Nijmegen, The Netherlands. S.Bredie@aig.azn.nl
Bosch
F H
FH
Demacker
P N
PN
Stalenhoef
A F
AF
van Leusen
R
R
D018592:Cross-Over Studies; D005260:Female; D005936:Glucans / Q000378:metabolism*; D005947:Glucose / Q000378:metabolism*; D015312:Hemodialysis Solutions / Q000378:metabolism*; D006801:Humans; D000077607:Icodextrin; D008074:Lipoproteins / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011446:Prospective Studies; D013997:Time Factors
D005936:Glucans; D015312:Hemodialysis Solutions; D008074:Lipoproteins; D000077607:Icodextrin; D005947:Glucose