[Effect of using icodextrin as a starting therapy for peritoneal permeability].
Peritoneal permeability differs between patients at the time of starting peritoneal dialysis (PD) and it can increase along with time on the technique. This fact is related to peritonitis, the biocompatibility of the dialysis fluids and the use of glucose as osmotic agent. The aim of the present study was to evaluate if the use of one exchange a day of icodextrine from the time of DP initiation affects the evolution of peritoneal permeability.


METHODS
56 patients starting PD (mean age: 48.3 +/- 14.0; 62.5% males; 17.9% diabetics) that used one exchange a day with icodextrine from the time of starting PD. We performed a peritoneal transport kinetic study at the time of starting PD and then every 6 months during two years. We calculated the peritoneal mass transfer area coefficient of creatinine (Cr-MTAC) and urea (U-MTAC) as well as the D/P creatinine relationship (D/P Cr). As a control group we used the results of Cr-MTC of 249 patients that had used glucose as the only osmotic agent from the time of starting PD.


RESULTS
The peritoneal transport, calculated using Cr-MTC, U-MTC and D/P Cr, diminished at 12 months (11.7+/-5.7 vs. 8.1+/-3.1; 23.5+/-7.3 vs. 18.9+/-3.8; 0.72+/-0.09 vs. 0.67+/-0.08; respectively), staying stable afterwards.We found that high transporters (HA) patients (higher quatril Cr-MTC ) showed a higher diminution of Cr-MTAC along the first year of treatment. The diminution of Cr-MTAC after 12 months using icodextrine was significantly higher (p<0.001) that the one observed in the control group that only used glucose as osmotic agent (10.5+/-5.3 vs. 10.1+/-4.6). We found that high transporters (HA) patients (higher quatril Cr-MTC) showed a higher decrease of Cr-MTAC along the first year of treatment.


CONCLUSIONS
the use of icodextrine at the time of starting PD might help to correct the high transport status observed in some patients during the first months of treatment. The peritoneal transport kinetic studies performed at 6 and 12 months after starting PD are more representative of the long term peritoneal transport characteristics of the patients than those performed at the time of starting PD.
Fernández-Reyes
M J
MJ
Servicio de Nefrología, Hospital General de Segovia, Segovia, Spain. mfernandez@hgse.sacyl.es
Bajo
M A
MA
del Peso
G
G
Olea
T
T
Sánchez-Villanueva
R L
RL
González
E
E
Heras
M
M
Sánchez
R
R
Selgas
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001692:Biological Transport; D001810:Blood Volume / Q000187:drug effects; D003404:Creatinine / Q000378:metabolism; D015314:Dialysis Solutions / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005936:Glucans / Q000494:pharmacology / Q000627:therapeutic use*; D005947:Glucose / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D000077607:Icodextrin; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D008970:Molecular Weight; D009997:Osmotic Pressure / Q000187:drug effects; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods; D010537:Peritoneum / Q000098:blood supply / Q000502:physiology; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D010539:Permeability / Q000187:drug effects; D012964:Sodium / Q000378:metabolism; D014508:Urea / Q000378:metabolism; D055815:Young Adult
D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D014508:Urea; D012964:Sodium; D003404:Creatinine; D005947:Glucose