Icodextrin improves the fluid status of peritoneal dialysis patients: results of a double-blind randomized controlled trial.
Worsening fluid balance results in reduced technique and patient survival in peritoneal dialysis. Under these conditions, the glucose polymer icodextrin is known to enhance ultrafiltration in the long dwell. A multicenter, randomized, double-blind, controlled trial was undertaken to compare icodextrin versus 2.27% glucose to establish whether icodextrin improves fluid status. Fifty patients with urine output <750 ml/d, high solute transport, and either treated hypertension or untreated BP >140/90 mmHg, or a requirement for the equivalent of all 2.27% glucose exchanges, were randomized 1:1 and evaluated at 1, 3, and 6 mo. Members of the icodextrin group lost weight, whereas the control group gained weight. Similar differences in total body water were observed, largely explained by reduced extracellular fluid volume in those receiving icodextrin, who also achieved better ultrafiltration and total sodium losses at 3 mo (P < 0.05) and had better maintenance of urine volume at 6 mo (P = 0.039). In patients fulfilling the study's inclusion criteria, the use of icodextrin, when compared with 2.27% glucose, in the long exchange improves fluid removal and status in peritoneal dialysis. This effect is apparent within 1 mo of commencement and was sustained for 6 mo without harmful effects on residual renal function.
Davies
Simon J
SJ
University Hospital of North Staffordshire, Stoke-on-Trent, England. SimonDavies1@compuserve.com
Woodrow
Graham
G
Donovan
Kieron
K
Plum
Jörg
J
Williams
Paul
P
Johansson
Ann Catherine
AC
Bosselmann
Hans-Peter
HP
Heimbürger
Olof
O
Simonsen
Ole
O
Davenport
Andrew
A
Tranaeus
Anders
A
Divino Filho
Jose C
JC
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D001823:Body Composition / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology; D015314:Dialysis Solutions / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005936:Glucans / Q000008:administration & dosage*; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D000077607:Icodextrin; D007674:Kidney Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D014882:Water-Electrolyte Balance / Q000187:drug effects*
D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D005947:Glucose