Recommendations for the use of icodextrin in peritoneal dialysis patients.
Icodextrin is a starch-derived, high molecular weight glucose polymer, which has been shown to promote sustained ultrafiltration equivalent to that achieved with hypertonic (3.86%/4.25%) glucose exchanges during prolonged intraperitoneal dwells (up to 16 h). Patients with impaired ultrafiltration, particularly in the settings of acute peritonitis, high transporter status and diabetes mellitus, appear to derive the greatest benefit from icodextrin with respect to augmentation of dialytic fluid removal, amelioration of symptomatic fluid retention and possible prolongation of technique survival. Glycaemic control is also improved by substituting icodextrin for hypertonic glucose exchanges in diabetic patients. Preliminary in vitro and ex vivo studies suggest that icodextrin demonstrates greater peritoneal membrane biocompatibility than glucose-based dialysates, but these findings need to be confirmed by long-term clinical studies. This paper reviews the available clinical evidence pertaining to the safety and efficacy of icodextrin and makes recommendations for its use in peritonal dialysis.
Johnson
David W
DW
Princess Alexandra Hospital, Brisbane, Queensland, Australia. david_johnson@health.qld.gov.au
Agar
John
J
Collins
John
J
Disney
Alex
A
Harris
David C H
DC
Ibels
Lloyd
L
Irish
Ashley
A
Saltissi
David
D
Suranyi
Michael
M
D048909:Diabetes Complications; D005936:Glucans / Q000627:therapeutic use*; D005947:Glucose / Q000627:therapeutic use*; D017583:Hemodiafiltration; D015312:Hemodialysis Solutions / Q000627:therapeutic use*; D006801:Humans; D000077607:Icodextrin; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy; D010530:Peritoneal Dialysis; D015996:Survival Rate
D005936:Glucans; D015312:Hemodialysis Solutions; D000077607:Icodextrin; D005947:Glucose