Combination of crystalloid (glucose) and colloid (icodextrin) osmotic agents markedly enhances peritoneal fluid and solute transport during the long PD dwell.
BACKGROUND
Fluid and sodium removal is often inadequate in peritoneal dialysis patients with high peritoneal solute transport rate, especially when residual renal function is declining.


METHODS
We studied the effects of using simultaneous crystalloid (glucose) and colloid (icodextrin) osmotic agents on the peritoneal transport of fluid, sodium, and other solutes during 15-hour single-dwell exchanges using 3.86% glucose, 7.5% icodextrin, and a combination fluid with 2.61% glucose and 6.8% icodextrin in 7 prevalent peritoneal dialysis patients with fast peritoneal solute transport rate.


RESULTS
The combination fluid enhanced net ultrafiltration (mean 990 mL) and sodium removal (mean 158 mmol) compared with 7.5% icodextrin (mean net ultrafiltration 462 mL, mean net sodium removal 49 mmol). In contrast, the 3.86% glucose-based solution yielded negligible ultrafiltration (mean -85 mL) and sodium removal (mean 16 mmol). The combination solution resulted in significantly improved urea (+41%) and creatinine (+26%) clearances compared with 7.5% icodextrin.


CONCLUSIONS
A solution containing both crystalloid (glucose 2.61%) and colloid (icodextrin 6.8%) osmotic agents enhanced fluid removal by twofold and sodium removal by threefold compared with 7.5% icodextrin solution during a dwell of 15 hours, indicating that such a combination solution could represent a new treatment option for anuric peritoneal dialysis patients with high peritoneal solute transport rate.
Freida
Philippe
P
Department of Nephrology, Louis Pasteur District Hospital, 50102 Cherbourg, France. p.freida@ch-cherbourg.fr
Galach
Magda
M
Divino Filho
Jose C
JC
Werynski
Andrzej
A
Lindholm
Bengt
B
D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid; D005260:Female; D005936:Glucans / Q000008:administration & dosage*; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D000077607:Icodextrin; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D009995:Osmosis; D010530:Peritoneal Dialysis
D005936:Glucans; D000077607:Icodextrin; D005947:Glucose