Icodextrin Increases Technique Survival Rate in Peritoneal Dialysis Patients with Diabetic Nephropathy by Improving Body Fluid Management

Abstract

SummaryBackground and objectives There are still controversies whether peritoneal dialysis (PD) with icodextrin preserves residual renal and peritoneal membrane functions in patients with diabetes. However, there are no randomized controlled and long-term clinical trials in newly started PD patients with diabetic nephropathy.Design, setting, participants, & measurements Forty-one patients with diabetic nephropathy with ESRD were enrolled and randomly assigned to the glucose group (GLU) treated with 8 L of 1.5% or 2.5% glucose or an icodextrin group (ICO) treated with 1.5 or 2.0 L of 7.5% icodextrin-containing solutions. Technique failure, body fluid management, glucose and lipid metabolism, and residual renal and peritoneal functions and were evaluated over 2 years. ResultsThe technique survival rate was 71.4% in ICO and 45.0% in GLU, with most of the technique failure due to volume overload. ICO showed significantly better cumulative technique survival. Net ultrafiltration volume was significantly higher in ICO throughout the study period. There were no beneficial effects of icodextrin on hemoglobin A1c, glycoalbumin, and lipid profile at 24 months. Urine volume and residual renal function declined faster in ICO, but there were no significant differences between the two groups. For peritoneal function, no differences were observed in dialysis-to-plasma creatinine ratios during the observation. ConclusionsIn PD therapy for diabetic nephropathy, the use of icodextrin-containing solutions has a beneficial effect on technique survival, but there are no apparent benefits or disadvantages in residual renal and peritoneal functions compared with conventional PD with glucose solution.

Proteinuria as a Risk Factor for Decline in Residual Renal Function in Non-Diabetic Peritoneal Dialysis Patients

“…Some patients may be hypovolemic and have a repercussion on RRF, but initial urine volume in the High tertile group was greater than the ultrafiltration volume. There were no significant difference among the tertiles, but there was an increasing trend in the edema index as the tertile of proteinuria level increased Takatori et al showed that urine volume significantly decreased in the earlier period in patients using icodextrin compared with those using glucose solution; however, there was no significant difference between the two groups [31]. They also suggest that superior ultrafiltration may reduce the RRF if the duration of dialysis therapy is >2 years.…”

PD solutions: New and old

“…Patients were randomized to 8 L of 1.5% or 2.5% glucose solution or to 1.5 or 2.0 L of 7.5% icodextrin-containing solution. 38 Their results demonstrated that technique survival was 71.4% in the icodextrin group compared to 45.0% in the glucose-containing group, with most of the technique failure due to volume overload. Declines in urine volume and RRF were not signifi cant, even though they appeared to be greater in the icodextrin group.…”

Practical Considerations When Prescribing Icodextrin: A Narrative Review

“…A more recent randomized open-label trial enrolled 41 incident PD patients with diabetic nephropathy and assigned them to either an icodextrin or dextrose long dwell [18]. The technique survival rate was 71.4% in the icodextrin group and 45.0% in the dextrose group, with most of the technique failure due to volume overload.…”

“…The long-term implications of these findings on clinical outcomes and peritoneal membrane structure and function are unclear. While data on technique failure was lacking in the meta-analyses described above, one recent trial and Korean registry study suggest that icodextrin may increase technique survival rates [18,19]. More data will be needed to confirm these encouraging preliminary findings.…”