Predictors of a favourable response to icodextrin in peritoneal dialysis patients with ultrafiltration failure.
OBJECTIVE
Icodextrin is a starch-derived glucose polymer that causes sustained ultrafiltration in long dwells in peritoneal dialysis. The aim of this study was to assess factors that were predictive of an increment in ultrafiltration following the introduction of icodextrin in patients with refractory fluid overload.


METHODS
Thirty-nine patients (20 male/19 female, mean age 57.7 +/- 2.4 years) on peritoneal dialysis were enrolled in a prospective pretest/post-test, open-label study. All patients had symptomatic fluid overload refractory to fluid restriction (<800 mL/day), frusemide doses of 250 mg or more daily, optimization of dwell time and use of hypertonic dextrose. An icodextrin exchange was substituted for a 4.25% dextrose exchange for the long-dwell period.


RESULTS
After 1 month, median (interquartile range) 24 h ultrafiltration volume increased by 500 mL (interquartile range: 50-1000). An increase in ultrafiltration volume correlated positively with the dialyate : plasma creatinine ratio at 4 h (r = 0.498, P = 0.001) and negatively with the ratio of dialysate glucose concentrations at 4 and 0 h (r = -0.464, P = 0.003). On multivariate regression analysis, high transporter status was predictive of a greater ultrafiltration response to icodextrin relative to dextrose peritoneal dialysis exchanges. Age, sex, race, peritoneal dialysis duration, peritoneal dialysis modality, diabetes mellitus, baseline albumin, and baseline ultrafiltration volume were not significantly correlated with the change in ultrafiltration volume.


CONCLUSIONS
Icodextrin significantly augments ultrafiltration volumes in patients with refractory fluid overload. A high peritoneal membrane transporter status is the best predictor of a favourable ultrafiltration response to icodextrin.
Wiggins
Kathryn J
KJ
Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Brisbane 4102, Queensland, Australia.
Rumpsfeld
Markus
M
Blizzard
Sophie
S
Johnson
David W
DW
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001835:Body Weight; D015314:Dialysis Solutions / Q000008:administration & dosage*; D005260:Female; 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; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012709:Serum Albumin / Q000378:metabolism; D017211:Treatment Failure; D014462:Ultrafiltration
D015314:Dialysis Solutions; D005936:Glucans; D012709:Serum Albumin; D000077607:Icodextrin; D005947:Glucose