title: Icodextrin Simplifies PD Therapy by Equalizing UF and Sodium Removal Among Patient Transport Types During Long Dwells: A Modeling Study.
abstract: ♦
  
  
  BACKGROUND
  In recent years, results from clinical studies have changed the focus of peritoneal dialysis (PD) adequacy from small solute clearance to volume control, resulting in continued efforts to improve fluid and sodium removal in PD patients. We used a modified 3-pore model to theoretically predict fluid and solute removal using glucose-based and icodextrin solutions for a wide range of transport characteristics with automated PD (APD) and continuous ambulatory PD (CAPD) therapies. ♦
  
  
  METHODS
  Simulations were performed for the day (APD: 15-hr, 2.27% glucose and 7.5% icodextrin; CAPD: 3x5-hr, 1.36% and 2.27% glucose) and night (APD: 9-hr, 1.36% glucose; CAPD: 9-hr, 2.27% glucose and 7.5% icodextrin) dialysis periods separately. During APD, the number of night exchanges (N) was varied from 3 to 7. Ultrafiltration (UF), sodium removal (NaR), total carbohydrate absorption (CHO), UF efficiency (UFE), and sodium removal efficiency (NaRE) were calculated. Typical patients in fast (i.e. high, H), average (high-average, HA; low-average, LA), and slow (low, L) transport groups with no residual kidney function were considered. ♦
  
  
  RESULTS
  The effective dwell times varied between 1.0 and 14.7 hours depending on the number of exchanges. With glucose-based solutions, differences in UF and NaR between H and L transport patients ranged from 140 mL and 2 mmol (APD night, n = 7) to 778 mL and 56.4 mmol (CAPD day, 2.27%). With icodextrin, differences in UF and NaR ranged from 1 mL and 1.1 mmol (CAPD night) to 59 mL and 6.1 mmol (APD day). The use of icodextrin resulted in greater CHO than 2.27% glucose (APD: 27.1 - 35.6 g more; CAPD: 17.1 - 17.5 g more). The UFE and NaRE were greater for all patients with icodextrin than with glucose-based solution in both therapy modalities, except for slow transport patients in CAPD. ♦
  
  
  CONCLUSIONS
  This modeling study shows that the dependence of UF and NaR on patient transport type observed with glucose-based solutions can be minimized using icodextrin during the long dwells of APD and CAPD. While this approach simplifies the PD prescription by minimizing the dependencies of ultrafiltration and sodium removal on patient transport type when using icodextrin, it improves fluid and sodium removal efficiencies in fast and average transport patients without any added glucose exposure.
authors.affiliation: Medical Products, Global Technology and Innovation, Baxter Healthcare Corporation, Illinois, USA alp_akonur@baxter.com.
authors.forename: Alp
authors.initials: A
authors.lastname: Akonur
authors.affiliation: Medical Products, Renal, Baxter Healthcare Corporation, Illinois, USA.
authors.forename: James
authors.initials: J
authors.lastname: Sloand
authors.affiliation: Medical Products, Renal, Baxter Healthcare Corporation, Illinois, USA.
authors.forename: Ira
authors.initials: I
authors.lastname: Davis
authors.forename: John
authors.initials: J
authors.lastname: Leypoldt
mesh_terms: D005936:Glucans / Q000494:pharmacology*; D005947:Glucose / Q000494:pharmacology*; D015312:Hemodialysis Solutions; D006801:Humans; D000077607:Icodextrin; D008954:Models, Biological; D010530:Peritoneal Dialysis / Q000379:methods; D012964:Sodium; D013997:Time Factors; D014462:Ultrafiltration
chemical_list: D005936:Glucans; D015312:Hemodialysis Solutions; D000077607:Icodextrin; D012964:Sodium; D005947:Glucose
keywords: APD; CAPD; Ultrafiltration; icodextrin; sodium removal; sodium removal efficiency; ultrafiltration efficiency