Effects of icodextrin in automated peritoneal dialysis on blood pressure and bioelectrical impedance analysis

Woodrow, Graham; Oldroyd, B.; Stables, Gillian; Gibson, J.; Turney, J. H.; Brownjohn, A. M.

doi:10.1093/ndt/15.6.862

Cited by 79 publications

(77 citation statements)

References 20 publications

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“…The lack of influence of improved ultrafiltration on BP control in this study is on the surface disappointing and differs from the findings of uncontrolled studies (18,21,22). It should be noted, however, that achieved BP control throughout the study in both patient groups was very satisfactory, reflecting both a good quality of care by participating physicians and the freedom to use drug therapy as required in the study protocol.…”

Section: Discussioncontrasting

confidence: 92%

“…We found that when icodextrin is used during the long exchange compared with 2.27% glucose, ultrafiltration is better preserved and a sustained reduction in weight, primarily attributable to changes in the ECF, occurs. This supports the changes in weight observed in a recent randomized study (17) and in uncontrolled studies of manipulation of fluid status in PD patients, although in these reports, the changes in BP were greater (18,21,22). Furthermore, this change does not appear to have a detrimental effect of residual urine volume.…”

Section: Discussionsupporting

confidence: 85%

“…It is of particular value in patients with high solute transport (14), and several randomized trials have demonstrated better ultrafiltration compared with 2.27% glucose (15)(16)(17). A recent open study in APD patients, where icodextrin was used in the daytime dwell compared with 2.27% glucose, demonstrated clinically important changes in fluid content and BP control (18). In this study, we describe the results of a randomized, double-product, blinded, controlled trial of icodextrin versus 2.27% glucose in the long exchange designed to evaluate its effects on fluid status, body composition, BP, and cardiovascular risk factors.…”

mentioning

confidence: 99%

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Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients

Davies¹,

Woodrow

Donovan

et al. 2003

Journal of the American Society of Nephrology

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320

261

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Abstract. Worsening fluid balance results in reduced technique and patient survival in peritoneal dialysis. Under these conditions, the glucose polymer icodextrin is known to enhance ultrafiltration in the long dwell. A multicenter, randomized, double-blind, controlled trial was undertaken to compare icodextrin versus 2.27% glucose to establish whether icodextrin improves fluid status. Fifty patients with urine output Ͻ750 ml/d, high solute transport, and either treated hypertension or untreated BP Ͼ140/90 mmHg, or a requirement for the equivalent of all 2.27% glucose exchanges, were randomized 1:1 and evaluated at 1, 3, and 6 mo. Members of the icodextrin group lost weight, whereas the control group gained weight. Similar differences in total body water were observed, largely explained by reduced extracellular fluid volume in those receiving icodextrin, who also achieved better ultrafiltration and total sodium losses at 3 mo (P Ͻ 0.05) and had better maintenance of urine volume at 6 mo (P ϭ 0.039). In patients fulfilling the study's inclusion criteria, the use of icodextrin, when compared with 2.27% glucose, in the long exchange improves fluid removal and status in peritoneal dialysis. This effect is apparent within 1 mo of commencement and was sustained for 6 mo without harmful effects on residual renal function.

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Section: Discussioncontrasting

confidence: 92%

Section: Discussionsupporting

confidence: 85%

mentioning

confidence: 99%

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Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients

Davies¹,

Woodrow

Donovan

et al. 2003

Journal of the American Society of Nephrology

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320

261

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“…It is becoming increasingly clear that one of the primary responsibilities of clinicians in the management of PD patients is the balance between adequate control of fluid status and preservation of residual renal function. Numerous clinical studies (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(35)(36)(37) and more than 9 years of post-marketing surveillance have confirmed that icodextrin is a safe and well-tolerated osmotic alternative PD solution to glucose. The most significant adverse effect reported to date is a cutaneous hypersensitivity reaction (38,39).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Icodextrin and Glucose Solutions for Long Dwell Exchange in Peritoneal Dialysis: A Meta-Analysis of Randomized Controlled Trials

et al. 2011

Perit Dial Int

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♦ Background: Icodextrin is widely used in peritoneal dialysis (PD); however, the safety and efficacy of icodextrin are unclear. In the present study, we performed a systematic review of randomized controlled trials (RCTs) that compared icodextrin and glucose for the once-daily long dwell in PD. ♦ Methods: Electronic searches were performed in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to select all eligible studies. Eligible studies, as determined by consensus using predefined criteria, were reviewed, and data were extracted onto a standard form. ♦ Results: In the 9 RCTs that were identified, patients using icodextrin were found to have much greater net ultrafiltration (UF) and a lower incidence of negative net UF compared to patients using 1.5%, 2.5%, and 4.25% glucose solutions. Additionally, icodextrin has a markedly increased UF efficiency ratio and peritoneal clearance of creatinine and urea nitrogen, but residual renal function was not different from patients using glucose solutions for PD. No significant differences were observed between icodextrin and glucose groups with respect to risk of mortality, peritonitis, and total adverse events. Although rashes occurred significantly more often in icodextrin groups, few differences were noted between icodextrin and glucose groups when withdrawal rates secondary to adverse events were compared. ♦ Conclusions: This meta-analysis suggests that icodextrin provides patients with greater fluid removal and small solute clearance and does not cause any damage to residual renal function. Icodextrin is particularly appropriate for use in patients with high peritoneal transport status.

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“…As the sieving coefficient for sodium is about 0.6, i.e., that less sodium than water is removed with hypertonic exchanges that are glucose based (21), it may be posited that the efficacy of ultrafiltration in normalizing sodium/volume status is limited. It is noteworthy that when a glucose polymer (icodextrin) is used in place of glucose, a set of pores with larger mean radius is engaged (22) to move sodium and water into the peritoneal space and that there is no membrane restriction to sodium transport (23). Sodium then sieves at 1.0 as ultrafiltrate and plasma water carry identical sodium concentrations.…”

Section: Editorialmentioning

confidence: 99%

Therapeutic use of the Dialysis Prescription for Improvement in Blood Pressure Control

Henderson

Owen

2002

Int J Artif Organs

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Effects of icodextrin in automated peritoneal dialysis on blood pressure and bioelectrical impedance analysis

Abstract: Use of icodextrin for the daytime dwell in APD results in improved fluid balance and blood pressure control compared with 2.27% glucose. MFBIA detected clinically important changes in fluid content in these patients.

Cited by 79 publications

References 20 publications

Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients

Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients

Comparison of Icodextrin and Glucose Solutions for Long Dwell Exchange in Peritoneal Dialysis: A Meta-Analysis of Randomized Controlled Trials

Therapeutic use of the Dialysis Prescription for Improvement in Blood Pressure Control

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