title: Superiority of icodextrin compared with 4.25% dextrose for peritoneal ultrafiltration.
abstract: Several clinical observations suggest the superiority of icodextrin compared with 4.25% dextrose in optimizing peritoneal ultrafiltration (UF), but no rigorous controlled evaluation has hitherto been performed. For comparing icodextrin and 4.25% dextrose during the long dwell of automated peritoneal dialysis, a multicenter, randomized, double-blind trial was conducted in 92 patients (control, 45; icodextrin, 47) with 4-h dialysate to plasma ratio creatinine >0.70 and D/D(0) glucose <0.34. Long-dwell net UF and the UF efficiency ratio (net UF volume per gram of dialysate carbohydrate absorbed) were determined at baseline, week 1, and week 2. The control and treatment groups were comparable at baseline (all patients using 4.25% dextrose for the long dwell) with regard to mean (+/-SEM) net UF (201.7 +/- 103.1 versus 141.6 +/- 75.4 ml, respectively; P = 0.637) and the percentage of patients with negative net UF (control, 37.8%; treatment, 42.6%; P = 0.641). During the study period, net UF was unchanged from baseline in the control group but increased significantly (P < 0.001) in the icodextrin group from 141.6 +/- 75.4 to 505.8 +/- 46.8 ml at week 1 and 540.2 +/- 46.8 ml at week 2. In the icodextrin group, the incidence of negative net UF was significantly lower (P < 0.0001) than in the control group. Findings were similar for UF efficiency ratio. Rash was reported significantly more often in the icodextrin group. This study showed that in high-average and high transporters, icodextrin is superior to 4.25% dextrose for long-dwell fluid and solute removal.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Fredric
authors.initials: F
authors.lastname: Finkelstein
authors.forename: Helen
authors.initials: H
authors.lastname: Healy
authors.forename: Ali
authors.initials: A
authors.lastname: Abu-Alfa
authors.forename: Suhail
authors.initials: S
authors.lastname: Ahmad
authors.forename: Fiona
authors.initials: F
authors.lastname: Brown
authors.forename: Todd
authors.initials: T
authors.lastname: Gehr
authors.forename: Kevin
authors.initials: K
authors.lastname: Nash
authors.forename: Michael
authors.initials: M
authors.lastname: Sorkin
authors.forename: Salim
authors.initials: S
authors.lastname: Mujais
mesh_terms: D015314:Dialysis Solutions / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005936:Glucans / Q000494:pharmacology*; D005947:Glucose / Q000494:pharmacology*; D006801:Humans; D000077607:Icodextrin; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014462:Ultrafiltration / Q000379:methods*
chemical_list: D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D005947:Glucose