Icodextrin Dialysate Improves Nutritional and Inflammatory Profiles in Peritoneal Dialysis Patients

Abstract

Background. Previous studies demonstrate that icodextrin is superior to 4.25% dextrose for fluid removal in patients with high and high-average transport membrane. Recent studies reveal that controlling volume status improves malnutrition in peritoneal dialysis (PD) patients. This study hypothesized that icodextrin enhances nutritional and inflammatory status by improving fluid balance. Methods. This retrospective case-control study investigated the effects of icodextrin on patient nutritional profiles over a one-year period. Thirty-two patients who used icodextrin for more than one year were classified as the "icodextrin group." Ten patients who used glucose-containing dialysate without icodextrin were classified as the control group. Clinical and laboratory parameters were compared between groups. Demographic and laboratory parameters were analyzed at baseline, 3 months, 6 months, and 12 months after starting icodextrin dialysis. Results. Ultrafiltration of icodextrin per exchange in the icodextrin group was 66% higher than that for 4.25% dextrose exchange in the icodextrin group (icodextrin vs. 4.25% dextrose: 492.1 ± 204.5 vs. 296.1 ± 115.3 mL/exchange; p < 0.0001, paired t-test). The increased albumin and normalized protein catabolic rate (nPCR) after icodextrin for one year was unique for the icodextrin group (p < 0.0001 and p < 0.0001, respectively). The inflammatory marker high sensitivity C-reactive protein (hsCRP) decreased significantly only in the icodextrin group (p = 0.0048). Conclusion. Icodextrin dialysate may improve nutritional and inflammatory status in PD patients. However, the long-term clinical effects of icodextrin require further study.

Do We Have a Biocompatible Peritoneal Dialysis Fluid?

“…Martikainen et al showed that Icodextrin use was resulted in subclinical inflammatory response [11]. In contrast, Lin et al reported that Icodextrin decreased CRP [12]. In this study the basal serum CRP and fibrinogen levels were similar and elevated in both study groups ( Table 3).…”

“…The effects of Icodextrin on inflammation status in PD patients are controversial [11,12]. Martikainen et al showed that Icodextrin use was resulted in subclinical inflammatory response [11].…”

“…Icodextrin PDF is targeted to have more sustained oncotic effect, to reduce plasma glucose and glucose-induced lipid abnormalities, and to avoid the production of glucose degradation products (GDPs) [9,10]. Generally, there is some concern that Icodextrin treatment may induce a subclinical inflammatory response, both intraperitoneally and systemically [10][11][12]. AAPDF was designed to correct nutriational status by supplying extra nitrogen through the intraperitoneal route [13].…”

Biocompatible Peritoneal Dialysis Solutions

“…In a study of 22 patients, Martikainen et al (55) showed that there was an increase in serum C-reactive protein (CRP) levels, as well as dialysate IL-6 and TNF alpha with 8 weeks of icodextrin use. However, in another study comparing 32 PD patients using icodextrin to 10 patients not using icodextrin, the inflammatory marker highsensitivity CRP decreased significantly only in the icodextrin group (P ϭ 0.0048) (56). In a series of eight anuric patients from Japan who were switched from glucose solutions to icodextrin (long-dwell exchange), the effluent leukocyte counts and fibrin degradation products were increased at 12 and 36 weeks after the switch to icodextrin, whereas IL-6 and CA-125 levels stayed the same (57).…”

Relationship between CRP Polymorphism and Cardiovascular Events in Chinese Peritoneal Dialysis Patients

“…Experimental evidence indicates that serum CRP levels increased during PD (32)(33)(34). Glucose and glucose degradation products in the PD solutions can increase CRP levels of PD patients (35,36). CRP is known to positively correlate with cardiovascular events and mortality in PD patients (3,7,(14)(15)(16)(17).…”