Practical Considerations When Prescribing Icodextrin: A Narrative Review

Abstract

Background: Icodextrin is a peritoneal dialysis solution that is commonly used to increase ultrafiltration during the long dwell. The other major clinical benefit of icodextrin is that it is glucose-sparing, which may help preserve peritoneal membrane function. Since it has a different chemical composition than dextrose, and with its increasing use, there are several clinical considerations healthcare providers must familiarize themselves with prior to prescribing icodextrin. Summary: Failure to recognize these special properties of icodextrin can lead to adverse events reaching patients. This narrative review explores the hemodynamic, metabolic, and idiopathic effects of icodextrin to facilitate the safe use of icodextrin in peritoneal dialysis. Key Messages: Hemodynamic effects include hypotension from enhanced ultrafiltration contributing to loss of residual kidney function. Metabolic effects include the chemical structure of icodextrin interfering with biochemical assays, resulting in misleading glucose readings on non-specific glucometers. Idiopathic adverse effects include a diffuse rash and sterile peritonitis. It is also important to remember that not all antibiotic combinations have undergone stability testing in icodextrin. This narrative review will help healthcare providers to confidently prescribe icodextrin to maximize its benefit in peritoneal dialysis patients.

Delayed Allergic Cutaneous Hypersensitivity to Icodextrin

“…[1][2][3][4] Icodextrin is partially absorbed from the peritoneum via the peritoneal lymphatic drainage. [8][9][10] Maltose, a metabolite of icodextrin, is structurally similar to dextran which is used as a plasma expander, is also known to cause allergic reactions in studies.…”

“…1 It is plausible that these immune complex could potentially be triggering a delayed cutaneous reaction in patients. 9,10 There is, however, no known icodextrin epitope responsible for allergic reactions. 10 The delayed skin reaction might share a common pathway with persistent pruritus seen with similar compounds like hydroxyethyl starch (HES) infusion, which is used as an intravascular volume expander.…”

“…9,10 There is, however, no known icodextrin epitope responsible for allergic reactions. 10 The delayed skin reaction might share a common pathway with persistent pruritus seen with similar compounds like hydroxyethyl starch (HES) infusion, which is used as an intravascular volume expander. 11 Immunoelectron microscopic evaluation of skin biopsies in patients with pruritus after exposure to HES showed vacuolization and deposition in Schwann cells, endoneural and perineural cells.…”

Les spécificités du soin nutritionnel en dialyse péritonéale

“…L'utilisation de solutions à base de polymè res du glucose (icodextrine) permet un meilleur contrô le du profil lipidique et de l'inflation hydrosodé e, et fait partie des straté gies d'é pargne en glucose. Cependant, d'autres effets mé taboliques sont à prendre en considé ration lors de sa prescription [37,38]. Rappelons é galement la mise en garde de l'Agence nationale de sé curité du mé dicament et des produits de santé (ANSM) concernant l'utilisation des lecteurs glycé miques et des bandelettes ré actives, dont certaines sont contre-indiqué es en raison de l'interfé rence entre le mé tabolite de la solution (maltose) et les ré actifs de lecteurs utilisant comme principe de mesure l'enzyme glucose dé shydrogé nase pyrroloquinolé inequinone (GDH-PQQ) ou glucosedye-oxidoré ductase sur les bandelettes ré actives (hypoglycé mies sé vè res « normoglycé miques » ou injection d'insuline pour hypoglycé mie n'existant pas).…”

Effect of Neutral pH Icodextrin Peritoneal Dialysis Fluid on Mesothelial Cells

“…Icodextrin PDF is useful for PD patients because of factors such as the high ability for ultrafiltration and Na removal . However, various bio‐incompatibilities have been reported, such as the low (acidic) pH.…”