Effects of icodextrin on glycemic and lipid profiles in diabetic patients undergoing peritoneal dialysis.
OBJECTIVE
Icodextrin reduces glucose absorption from the peritoneal dialysate. We conducted this prospective, open-labeled, multicenter study to determine the effects of icodextrin on glycemic and lipid parameters in diabetic patients undergoing continuous ambulatory peritoneal dialysis (PD) or automated PD.


METHODS
Patients were recruited from 15 institutions in Japan, and a total of 51 patients (15 women and 36 men, mean age: 59 +/- 10 years, median duration of PD: 13 months) were enrolled. The patients were administered an overnight or daytime dwell of 1.5 or 2.0 l of 7.5% icodextrin-containing solution. At baseline and 3, 6, 9 and 12 months after the start of icodextrin, nonfasting blood was drawn for measurement of glycated hemoglobin (HbA1C) and serum lipids.


RESULTS
During icodextrin treatment, there was no change in overall HbA1C levels compared to baseline values; however, for those with baseline HbA1C > or =6.5% (n = 22), significant decreases in HbA1C were observed. Mean total/LDL cholesterol and triglycerides were decreased significantly during icodextrin treatment, with greater decreases for patients with baseline total cholesterol > or =220 mg/dl, LDL cholesterol > or =120 mg/dl or triglycerides > or =150 mg/dl. HDL cholesterol did not differ at any time point; however, values for patients with baseline HDL cholesterol <40 mg/dl tended to increase with marginal significance.


CONCLUSIONS
In the current study, switching from glucose-containing dialysis solution to icodextrin resulted in improved lipid profiles and possibly a favorable metabolic profile, particularly in patients with poor glycemic control. These hypotheses remain to be proven in controlled clinical trials.
Babazono
Tetsuya
T
Division of Nephrology and Hypertension, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan. babazono@dmc.twmu.ac.jp
Nakamoto
Hidetomo
H
Kasai
Kenji
K
Kuriyama
Satoru
S
Sugimoto
Tokuichiro
T
Nakayama
Masaaki
M
Hamada
Chieko
C
Furuya
Ryuichi
R
Hasegawa
Hirofumi
H
Kasahara
Masato
M
Moriishi
Misaki
M
Tomo
Tadashi
T
Miyazaki
Masanobu
M
Sato
Manaka
M
Yorioka
Noriaki
N
Kawaguchi
Yoshindo
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050260:Carbohydrate Metabolism / Q000187:drug effects*; D003928:Diabetic Nephropathies / Q000628:therapy*; D015314:Dialysis Solutions / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005936:Glucans / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D005947:Glucose / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D000077607:Icodextrin; D050356:Lipid Metabolism / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory
D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D005947:Glucose