title: An exploratory study of a novel peritoneal combination dialysate (1.36% glucose/7.5% icodextrin), demonstrating improved ultrafiltration compared to either component studied alone.
abstract: OBJECTIVE
  Concerns regarding the impact of ultrafiltration failure on peritoneal dialysis and the effect of hypertonic glucose on the peritoneal membrane have lead to a search for alternative dialysates. Computer simulations based on the three-pore theory suggest that a combination of 1.36% glucose and 7.5% icodextrin (glucose polymer) offers an improved ultrafiltration profile. The aim of the present study was to investigate the ultrafiltration profile of this combination fluid.
  
  
  METHODS
  Prospective open study comparing 1.36% glucose, 3.86% glucose, 7.5% icodextrin, and the combination fluid (1.36% glucose/7.5% icodextrin).
  
  
  METHODS
  Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK.
  
  
  METHODS
  11 patients currently using peritoneal dialysis not previously exposed to icodextrin.
  
  
  METHODS
  Intraperitoneal volume was measured using a radioisotope dilution method.
  
  
  RESULTS
  The combination fluid showed a biphasic ultrafiltration profile, with a steep initial increase in intraperitoneal volume, then a maintained plateau phase for the duration of the study dwell (7 hours). The final volume was greater than that with the 1.36% glucose dwell and the 7.5% icodextrin dwell. The fluid was well tolerated by the patients.
  
  
  CONCLUSIONS
  These findings are in keeping with computer simulations using the three-pore model. The combination fluid offers an improved ultrafiltration profile, with a final volume similar to 3.86% glucose, while avoiding exposing the peritoneal membrane to high glucose concentrations. It may have a role as a long dwell to optimize ultrafiltration and possibly prolong peritoneal dialysis technique survival.
authors: Sheffield Kidney Institute, Northern General Hospital, Sheffield University Hospital Trust, Sheffield, South Yorkshire, United Kingdom. Sbjenksi@hotmail.com
authors: Sarah B
authors: SB
authors: Jenkins
authors: Martin E
authors: ME
authors: Wilkie
mesh_terms: D000328:Adult; D015314:Dialysis Solutions / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004359:Drug Therapy, Combination; D005260:Female; D005936:Glucans / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005947:Glucose / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D000077607:Icodextrin; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D011446:Prospective Studies; D011865:Radioisotope Dilution Technique; D014462:Ultrafiltration / Q000379:methods
chemical_list: D015314:Dialysis Solutions; D005936:Glucans; D007457:Iodine Radioisotopes; D000077607:Icodextrin; D005947:Glucose