title: Icodextrin increases technique survival rate in peritoneal dialysis patients with diabetic nephropathy by improving body fluid management: a randomized controlled trial.
abstract: OBJECTIVE
  There are still controversies whether peritoneal dialysis (PD) with icodextrin preserves residual renal and peritoneal membrane functions in patients with diabetes. However, there are no randomized controlled and long-term clinical trials in newly started PD patients with diabetic nephropathy.
  
  
  METHODS
  Forty-one patients with diabetic nephropathy with ESRD were enrolled and randomly assigned to the glucose group (GLU) treated with 8 L of 1.5% or 2.5% glucose or an icodextrin group (ICO) treated with 1.5 or 2.0 L of 7.5% icodextrin-containing solutions. Technique failure, body fluid management, glucose and lipid metabolism, and residual renal and peritoneal functions and were evaluated over 2 years.
  
  
  RESULTS
  The technique survival rate was 71.4% in ICO and 45.0% in GLU, with most of the technique failure due to volume overload. ICO showed significantly better cumulative technique survival. Net ultrafiltration volume was significantly higher in ICO throughout the study period. There were no beneficial effects of icodextrin on hemoglobin A1c, glycoalbumin, and lipid profile at 24 months. Urine volume and residual renal function declined faster in ICO, but there were no significant differences between the two groups. For peritoneal function, no differences were observed in dialysis-to-plasma creatinine ratios during the observation.
  
  
  CONCLUSIONS
  In PD therapy for diabetic nephropathy, the use of icodextrin-containing solutions has a beneficial effect on technique survival, but there are no apparent benefits or disadvantages in residual renal and peritoneal functions compared with conventional PD with glucose solution.
authors.affiliation: Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takatori
authors.forename: Shigeru
authors.initials: S
authors.lastname: Akagi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Junko
authors.initials: J
authors.lastname: Inoue
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Kojo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morinaga
authors.forename: Kazushi
authors.initials: K
authors.lastname: Nakao
authors.forename: Jun
authors.initials: J
authors.lastname: Wada
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Makino
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015314:Dialysis Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005936:Glucans / Q000009:adverse effects / Q000627:therapeutic use*; D005947:Glucose / Q000009:adverse effects / Q000627:therapeutic use*; D006442:Glycated Hemoglobin / Q000378:metabolism; D017127:Glycation End Products, Advanced; D006801:Humans; D000077607:Icodextrin; D007564:Japan; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects; D011446:Prospective Studies; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance; D000093423:Glycated Serum Albumin
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D003404:Creatinine; D015314:Dialysis Solutions; D005936:Glucans; D005947:Glucose; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D000077607:Icodextrin; D008055:Lipids; D012709:Serum Albumin; D000093423:Glycated Serum Albumin; C517652:hemoglobin A1c protein, human