title: Effect of icodextrin on heart rate variability in diabetic patients on peritoneal dialysis.
abstract: BACKGROUND
  Spectral analysis of heart rate variability is a noninvasive method for evaluating autonomic cardiovascular dysfunction under various clinical conditions, such as in dialysis patients, in whom an imbalance between the sympathetic and parasympathetic nervous system appears to be an important risk factor for sudden cardiovascular death and arrhythmia. ♢
  
  
  OBJECTIVE
  We compared the effect of icodextrin-based dialysis solution, an option that allows for better metabolic and fluid overload control, with that of glucose-based dialysis fluid on sympathetic and parasympathetic activity in the heart, as assessed by heart rate variability, in diabetic patients on peritoneal dialysis (PD). ♢
  
  
  METHODS
  This secondary analysis uses data from a randomized controlled trial in diabetic PD patients with high or high-average peritoneal transport using icodextrin-based (ICO group, n = 30) or glucose-based (GLU group, n = 29) solutions for the long dwell. All patients underwent 24-hour electrocardiographic Holter monitoring at baseline, and at 6 and 12 months of follow-up. ♢
  
  
  RESULTS
  We observed no significant differences between the groups in most of the variables analyzed, although values were, in general, below reference values. In the ICO group, total power and both low- and high-frequency power in normalized units increased, but the percentage of RR intervals with variation of more than 50 ms declined over time; in the GLU group, all those values declined. Plasma catecholamine levels were higher at baseline and declined over time. ♢
  
  
  CONCLUSIONS
  These results indicate a partial recovery of sympathetic activity in the ICO group, probably because of better extracellular fluid control and lower exposure to glucose with the use of icodextrin-based dialysis solutions.
authors: Unidad de Investigación Médica en Enfermedades Nefrológicas,1 Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México City;
authors: Oscar
authors: O
authors: Orihuela
authors: María
authors: M
authors: de Jesús Ventura
authors: Marcela
authors: M
authors: Ávila-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: Guadalupe
authors: G
authors: Alcántara
authors: Bengt
authors: B
authors: Lindholm
authors: Elvia
authors: E
authors: García-López
authors: Cleva
authors: C
authors: Villanueva
authors: Ramón
authors: R
authors: Paniagua
mesh_terms: D016757:Death, Sudden, Cardiac; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D015314:Dialysis Solutions / Q000494:pharmacology*; D005260:Female; D005936:Glucans / Q000494:pharmacology*; D005947:Glucose / Q000494:pharmacology*; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D000077607:Icodextrin; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis
chemical_list: D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D005947:Glucose
keywords: End-stage renal disease; diabetes; heart rate variability; high peritoneal transport type; icodextrin