Effects of Twice-Daily Icodextrin Administration on Blood Pressure and Left Ventricular Mass in Patients on Continuous Ambulatory Peritoneal Dialysis

Abstract

Background Hypervolemia is a risk factor for left ventricular hypertrophy and hypertension in peritoneal dialysis patients. Icodextrin improves volume control by increasing ultrafiltration in peritoneal dialysis patients. Aim To examine the effects of twice-daily icodextrin administration on blood pressure and left ventricular hypertrophy in peritoneal dialysis patients with hypervolemia and ultrafiltration failure. Method and Results Administration of icodextrin twice daily resulted in a significant reduction in the left ventricular mass index (LVMI) of patients by the end of the third month ( p < 0.05). The reduction in LVMI was also significant for the once-daily icodextrin group ( p < 0.05). Mean blood pressure of patients receiving icodextrin twice daily was significantly reduced ( p < 0.05). By the end of the third month no significant changes were observed in mean blood pressure of the patients using once-daily icodextrin ( p > 0.05). No statistically significant changes were observed in weekly total creatinine clearances or Kt/V of patients in either group at the end of 3 months (NS). Conclusion Twice-daily icodextrin administration was clinically beneficial as shown by reduced blood pressure and prevention of the progress of left ventricular hypertrophy without causing any decrease in dialysis adequacy or any side effects. The icodextrin metabolite results did not suggest any further increase in their values when comparing once- to twice-daily administration of icodextrin. Although prescription of icodextrin once daily may yield good clinical results in the long term, this study showed that it may be more efficient to use twice-daily icodextrin for at least a specific period for the purpose of obtaining quicker results in patients with ultrafiltration failure, serious hypervolemia, or hard-to-control blood pressure conditions.

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…solutions (high transporter), using higher tonicity glucosebased solutions (but this is less preferable), using icodextrin for long day dwell for APD or long overnight dwell for continuous ambulatory PD, restricting dietary salt, and in those with RKF, using diuretics to increase urine volume ( Figure 3). 55,100 Experimental approaches include using a low-sodium dialysate, 101 a bimodal solution with glucose and icodextrin, 102 2 icodextrin exchanges per day, 103 and incorporating intermittent hybrid therapy, all of which require further evaluation. Assessment of membrane function may be considered as adjunctive to clinical measures of UF volume.…”

The Patient Receiving Automated Peritoneal Dialysis with Volume Overload

“…Maximal UF typically occurs at 10 hours (7), so one may consider a shorter 10-hour icodextrin dwell followed by either a dry period or a 4-6 hour glucose-based exchange as needed to maximize UF. Twice daily icodextrin may enhance fluid removal, but experience is preliminary (8).…”

PD solutions: New and old

“…39 However, this suggestion was based on three small, low-powered studies. [40][41][42] Another study by Jeloka et al showed that UF does not increase after a 10-hour dwell with icodextrin. 43 Based on this, Dousdampanis and colleagues hypothesized that two 8-hour exchanges with icodextrin could produce more UF than a single 15-16hour exchange.…”