Effect of icodextrin on volume status, blood pressure and echocardiographic parameters: a randomized study.
Overhydration is a risk factor for hypertension and left ventricular hypertrophy in peritoneal dialysis patients. Recently, a high prevalence of subclinical overhydration was observed in peritoneal dialysis patients. Aim of the present open-label randomized study was to assess the effect of a icodextrin 7.5% solution on fluid status [extracellular water (ECW) bromide dilution], blood pressure regulation (24-hour ambulatory measurements) and echocardiographic parameters during a study period of 4 months, and to relate the effect to peritoneal membrane characteristics (dialysate/plasma creatinine ratio). Forty peritoneal dialysis patients (22 treated with icodextrin, 18 controls) were randomized to either treatment with icodextrin during the long dwell or standard glucose solutions. Thirty-two patients (19 treated with icodextrin, 13 controls] completed the study. The use of icodextrin resulted in a significant increase in daily ultrafiltration volume (744 +/- 767 mL vs. 1670 +/- 1038 mL; P = 0.012) and a decrease in ECW (17.5 +/- 5.2 L vs. 15.8 +/- 3.8 L; P = 0.035). Also the change in ECW between controls and patients treated with icodextrin was significant (-1.7 +/- 3.3 L vs. +0.9 +/- 2.2 L; P = 0.013). The effect of icodextrin on ECW was not related to peritoneal membrane characteristics, but significantly related to the fluid state of the patients (ECW:height) (r = -0.72; P < 0.0001). Left ventricular mass (LVM) decreased significantly in the icodextrin-treated group (241 +/- 53 grams vs. 228 +/- 42 grams; P = 0.03), but not in the control group. In this randomized open-label study, the use of icodextrin resulted in a significant reduction in ECW and LVM. The effect of icodextrin on ECW was not related to peritoneal membrane characteristics, but was related to the initial fluid state of the patient.
Konings
Constantijn J A M
CJ
Department of Internal Medicine, University Hospital Maastricht, The Netherlands.
Kooman
Jeroen P
JP
Schonck
Marc
M
Gladziwa
Ulrich
U
Wirtz
Joris
J
van den Wall Bake
A Warmold
AW
Gerlag
Paul G
PG
Hoorntje
Steven J
SJ
Wolters
Johannes
J
van der Sande
Frank M
FM
Leunissen
Karel M L
KM
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001810:Blood Volume; D001823:Body Composition; D001835:Body Weight; D015314:Dialysis Solutions / Q000008:administration & dosage*; D004231:Diuresis; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D005936:Glucans / Q000008:administration & dosage*; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D000077607:Icodextrin; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D010537:Peritoneum / Q000378:metabolism; D014882:Water-Electrolyte Balance
D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D005947:Glucose