title: Effect of icodextrin on volume status, blood pressure and echocardiographic parameters: a randomized study.
abstract: 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.
authors.affiliation: Department of Internal Medicine, University Hospital Maastricht, The Netherlands.
authors.forename: Constantijn J A M
authors.initials: CJ
authors.lastname: Konings
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
authors.forename: Marc
authors.initials: M
authors.lastname: Schonck
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gladziwa
authors.forename: Joris
authors.initials: J
authors.lastname: Wirtz
authors.forename: A Warmold
authors.initials: AW
authors.lastname: van den Wall Bake
authors.forename: Paul G
authors.initials: PG
authors.lastname: Gerlag
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hoorntje
authors.forename: Johannes
authors.initials: J
authors.lastname: Wolters
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.forename: Karel M L
authors.initials: KM
authors.lastname: Leunissen
mesh_terms: 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
chemical_list: D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D005947:Glucose