Recommendations for the use of icodextrin in peritoneal dialysis patients

Abstract

SUMMARY:Icodextrin is a starch-derived, high molecular weight glucose polymer, which has been shown to promote sustained ultrafiltration equivalent to that achieved with hypertonic (3.86%/4.25%) glucose exchanges during prolonged intraperitoneal dwells (up to 16 h). Patients with impaired ultrafiltration, particularly in the settings of acute peritonitis, high transporter status and diabetes mellitus, appear to derive the greatest benefit from icodextrin with respect to augmentation of dialytic fluid removal, amelioration of symptomatic fluid retention and possible prolongation of technique survival. Glycaemic control is also improved by substituting icodextrin for hypertonic glucose exchanges in diabetic patients. Preliminary in vitro and ex vivo studies suggest that icodextrin demonstrates greater peritoneal membrane biocompatibility than glucose-based dialysates, but these findings need to be confirmed by long-term clinical studies. This paper reviews the available clinical evidence pertaining to the safety and efficacy of icodextrin and makes recommendations for its use in peritonal dialysis.

Histomorphological and functional changes of the peritoneal membrane during long-term peritoneal dialysis

“…The immediate clinical consequence is ultrafiltration failure due to a hyperpermeable membrane. By the use of icodextrin in acute peritonitis, which is highly effective in the case of hyperpermeability, adequate ultrafiltration can usually be achieved [12].…”

Vascular endothelial growth factor receptor-3 is a novel target to improve net ultrafiltration in methylglyoxal-induced peritoneal injury

“…Icodextrin is a glucose polymer osmotic agent that is used to promote sustained ultrafiltration during long peritoneal dialysis dwells. 33,38 The disappearance of icodextrin from the peritoneal cavity was reported to be consistent with a constant rate of fluid transport from the peritoneal cavity, mainly via the lymphatics. 33 In our experiments, the drained volume of the 7.5% icodextrin peritoneal equilibration test identified the upregulation and suppression of lymphangiogenesis, even in the presence of inflammation on day 22 (Figure 6a).…”

Role of Peritoneal Ultrafiltration in Heart Failure Treatment

“…Filtration in PD is isosmotic to the plasma, but fluid loss with diuretic treatment is more hypotonic (43,44). When the amount of sodium removal is compared between peritoneal UF (PUF) and diuretic treatment, 130-150 mmol/L sodium is removed by PUF and 50-100 mmol/L sodium is removed by diuretic treatment (45).…”