Efficacy and safety of a 7.5% icodextrin peritoneal dialysis solution in patients treated with automated peritoneal dialysis.
In a randomized, prospective, multicenter study, we compared the safety, efficacy, and metabolic effects of a 7.5% icodextrin solution (Extraneal) with a 2.27% glucose solution for long dwell exchanges in patients undergoing automated peritoneal dialysis. Thirty-nine stable patients on automated peritoneal dialysis were randomized to receive either icodextrin (n = 20) or glucose 2.27% solution (n = 19). The study included a 2-week baseline period followed by a 12-week icodextrin treatment phase and a 2-week follow-up period when switching back to glucose. The average net ultrafiltration during the long dwell period was 278 +/- 43 mL/d for the icodextrin group and -138 +/- 81 mL/d for the control group (P < 0.001). The higher ultrafiltration volume with icodextrin was associated with higher creatinine (2.59 +/- 0.09 mL/min versus 2.16 +/- 0.11 mL/min) and urea (2.67 +/- 0.09 mL/min versus 2.28 +/- 0.12 mL/min) peritoneal clearances for the long dwell (both P < 0.001). Ultrafiltration rate per mass of carbohydrate absorbed was +5.2 +/- 1.2 microL/min/g in the icodextrin group and -5.5 +/- 2.8 microL/min/g in the glucose group (P < 0.001). In the icodextrin group, there was a decrease in serum sodium and chloride compared with baseline (P < 0.01). Total dialysate sodium removal increased in the icodextrin group from 226.7 mEq to 269.6 mEq (week 12, P < 0.001). Serum alpha-amylase activity decreased from 103 U/L to 16 U/L (P < 0.001). The total icodextrin plasma levels reached a steady-state concentration of 6,187 +/- 399 mg/L after 1 week of treatment. Urine volume and residual renal function were not specifically affected by icodextrin compared with glucose. None of the laboratory changes resulted in any reported clinically meaningful side effect. Icodextrin produced increased, sustained ultrafiltration during the long dwell period, increasing (convective) peritoneal clearance and sodium removal in automated peritoneal dialysis patients.
Plum
Joerg
J
Department of Nephrology and Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany. plum@uni-duesseldorf.de
Gentile
Stella
S
Verger
Christian
C
Brunkhorst
Reinhart
R
Bahner
Udo
U
Faller
Bernadette
B
Peeters
Jacky
J
Freida
Philippe
P
Struijk
Dick G
DG
Krediet
Raymond T
RT
Grabensee
Bernd
B
Tranaeus
Anders
A
Filho
José C Divino
JC
D000042:Absorption; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D005260:Female; D005936:Glucans / Q000009:adverse effects / Q000378:metabolism / Q000494:pharmacology*; D005947:Glucose / Q000009:adverse effects / Q000378:metabolism / Q000494:pharmacology*; D006801:Humans; D000077607:Icodextrin; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D012964:Sodium / Q000097:blood; D014462:Ultrafiltration
D005936:Glucans; D000077607:Icodextrin; D012964:Sodium; D005947:Glucose