title: Effect of Icodextrin Solution on the Preservation of Residual Renal Function in Peritoneal Dialysis Patients: A Randomized Controlled Study.
abstract: Although icodextrin solution has been highlighted in the fluid management compared to glucose-based solutions, proof of a beneficial effect of icodextrin solution on residual renal function (RRF) is lacking. We conducted a multicenter prospective randomized controlled open-label trial to investigate whether icodextrin solution can preserve RRF.One hundred patients with urine volume ≥750 mL/day from 8 centers in Korea were randomly assigned to receive 1 exchange of icodextrin solution for a ≥8 hour-dwell time and 2 exchanges of 1.5% glucose-based biocompatible neutral pH solution or 1 exchange of ≥2.5% and 2 exchanges of 1.5% glucose-based biocompatible solutions. Using mixed-effects general linear models, we analyzed changes in residual glomerular filtration rate (GFR) and daily urine volume at 1 year.Forty-nine patients were assigned to the icodextrin group and 51 to the glucose solution group. During follow-up, the slope of the decline in residual GFR was -0.170 mL/min/month/1.73 m² in the icodextrin group, while it was -0.155 mL/min/month/1.73 m² in the glucose solution group (95% confidence interval [CI], -0.06 to 0.10; P = 0.701). Daily urine volume decreased faster in the glucose solution group than in the icodextrin group (-31.02 vs -11.88 mL per month; 95% CI, -35.85 to -2.44; P = 0.025). Results were consistent when we analyzed using intention-to-treat and per protocol principles. There were no differences in fluid status, peritoneal ultrafiltration, and peritoneal transport between groups during follow-up.This study clearly showed that icodextrin solution preserves residual urine volume better than glucose solution.
authors.affiliation: From the Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Goyang-si, Gyeonggi-do (TIC, EWK); Department of Internal Medicine, School of Medicine, Ewha Womans University (D-RR); Department of Internal Medicine, Yonsei University College of Medicine, Seoul (T-HY, SHH); Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si (HJK); Department of Internal Medicine, Wonkwang University College of Medicine Sanbon Hospital, Gunpo-si, Gyeonggi-do (HWK); Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University, Incheon (JHC); Department of Internal Medicine, Seoul National University, Seoul (DKK); and Department of Internal Medicine, College of Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea (SJM, SYY).
authors.forename: Tae Ik
authors.initials: TI
authors.lastname: Chang
authors.forename: Dong-Ryeol
authors.initials: DR
authors.lastname: Ryu
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
authors.forename: Hyung Jong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Ea Wha
authors.initials: EW
authors.lastname: Kang
authors.forename: Hyunwook
authors.initials: H
authors.lastname: Kim
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Chang
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Kim
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Moon
authors.forename: Soo Young
authors.initials: SY
authors.lastname: Yoon
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D005936:Glucans / Q000009:adverse effects / Q000627:therapeutic use*; D005947:Glucose / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D000077607:Icodextrin; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D011446:Prospective Studies; D056910:Republic of Korea
chemical_list: D005936:Glucans; D000077607:Icodextrin; D005947:Glucose