Icodextrin improves metabolic and fluid management in high and high-average transport diabetic patients.
BACKGROUND
Icodextrin-based solutions (ICO) have clinical and theoretical advantages over glucose-based solutions (GLU) in fluid and metabolic management of diabetic peritoneal dialysis (PD) patients; however, these advantages have not yet been tested in a randomized fashion.


OBJECTIVE
To analyze the effects of ICO on metabolic and fluid control in high and high-average transport diabetic patients on continuous ambulatory PD (CAPD).


METHODS
A 12-month, multicenter, open-label, randomized controlled trial was conducted to compare ICO (n = 30) versus GLU (n = 29) in diabetic CAPD patients with high-average and high peritoneal transport characteristics. The basic daily schedule was 3 x 2 L GLU (1.5%) and either 1 x 2 L ICO (7.5%) or 1 x 2 L GLU (2.5%) for the long-dwell exchange, with substitution of 2.5% or 4.25% for 1.5% GLU being allowed when clinically necessary. Variables related to metabolic and fluid control were measured each month.


RESULTS
Groups were similar at baseline in all measured variables. More than 66% of the patients using GLU, but only 9% using ICO, needed prescriptions of higher glucose concentration solutions. Ultrafiltration (UF) was higher (198 +/- 101 mL/day, p < 0.05) in the ICO group than in the GLU group over time. Changes from baseline were more pronounced in the ICO group than in the GLU group for extracellular fluid volume (0.23 +/- 1.38 vs -1.0 +/- 1.48 L, p < 0.01) and blood pressure (systolic 1.5 +/- 24.0 vs -10.4 +/- 30.0 mmHg, p < 0.01; diastolic 1.5 +/- 13.5 vs -6.2 +/- 14.2 mmHg, p < 0.01). Compared to baseline, patients in the ICO group had better metabolic control than those in the GLU group: glucose absorption was more reduced (-17 +/- 44 vs -64 +/- 35 g/day) as were insulin needs (3.6 +/- 3.4 vs - 9.1 +/- 4.7 U/day, p < 0.01), fasting serum glucose (8.3 +/- 36.5 vs -37 +/- 25.8 mg/dL, p < 0.01), triglycerides (54.5 +/- 31.9 vs -54.7 +/- 39.9 mg/dL, p < 0.01), and glycated hemoglobin (0.79% +/- 0.79% vs -0.98% +/- 0.51%, p < 0.01). Patients in the ICO group had fewer adverse events related to fluid and glucose control than patients in the GLU group.


CONCLUSIONS
Icodextrin represents a significant advantage in the management of high transport diabetic patients on PD, improving peritoneal UF and fluid control and reducing the burden of glucose overexposure, thereby facilitating metabolic control.
Paniagua
Ramón
R
Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México City, México. jpaniaguas@cis.gob.mx
Ventura
María-de-Jesús
MD
Avila-Díaz
Marcela
M
Cisneros
Alejandra
A
Vicenté-Martínez
Marlén
M
Furlong
María-Del-Carmen
MD
García-González
Zuzel
Z
Villanueva
Diana
D
Orihuela
Oscar
O
Prado-Uribe
María-Del-Carmen
MD
Alcántara
Guadalupe
G
Amato
Dante
D
D000042:Absorption; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000502:physiology; D003920:Diabetes Mellitus / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D015314:Dialysis Solutions / Q000493:pharmacokinetics*; D045604:Extracellular Fluid / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005936:Glucans / Q000493:pharmacokinetics*; D005947:Glucose / Q000493:pharmacokinetics*; D006801:Humans; D000077607:Icodextrin; D017136:Ion Transport / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood*
D001786:Blood Glucose; D015314:Dialysis Solutions; D005936:Glucans; D014280:Triglycerides; D000077607:Icodextrin; D005947:Glucose