title: Icodextrin improves metabolic and fluid management in high and high-average transport diabetic patients.
abstract: 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.
authors: Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México City, México. jpaniaguas@cis.gob.mx
authors: Ramón
authors: R
authors: Paniagua
authors: María-de-Jesús
authors: MD
authors: Ventura
authors: Marcela
authors: M
authors: Avila-Díaz
authors: Alejandra
authors: A
authors: Cisneros
authors: Marlén
authors: M
authors: Vicenté-Martínez
authors: María-Del-Carmen
authors: MD
authors: Furlong
authors: Zuzel
authors: Z
authors: García-González
authors: Diana
authors: D
authors: Villanueva
authors: Oscar
authors: O
authors: Orihuela
authors: María-Del-Carmen
authors: MD
authors: Prado-Uribe
authors: Guadalupe
authors: G
authors: Alcántara
authors: Dante
authors: D
authors: Amato
mesh_terms: 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*
chemical_list: D001786:Blood Glucose; D015314:Dialysis Solutions; D005936:Glucans; D014280:Triglycerides; D000077607:Icodextrin; D005947:Glucose