The Utility of Two Daytime Icodextrin Exchanges to Reduce Dextrose Exposure in Automated Peritoneal Dialysis Patients: A Pilot Study of Nine Patients

Abstract

Background: The use of dextrose-containing solutions in peritoneal dialysis (PD) is thought to be associated with glucose-related toxicity both to the peritoneal membrane and systemically. There has, therefore, been considerable interest in minimizing the use of dextrose exposure during PD. The present study was designed to explore the use of icodextrin in patients with high/high-average transporter characteristics for two exchanges per day to minimize glucose exposure. Methods: We performed a 6-month prospective cohort study using two icodextrin exchanges per day in a group of high/high-average transporters maintained on automated PD. Icodextrin levels, serum sodium levels, and glucose exposure were measured at baseline, 3 and 6 months. Results: Nine patients completed the study protocol. While the total volume of PD solution remained the same, there was a reduction in mean glucose exposure from a baseline mean value of 410 ± 75 to 275 ± 57 g/day at 3 months and 300 ± 75 g/day at 6 months. Serum icodextrin levels rose from a baseline mean of 345 ± 145 to 615 ± 120 mg/dl at 3 months and 620 ± 108 mg/dl at 6 months. Serum sodium levels remained stable. Conclusion: The use of two (double) icodextrin exchanges in high/high-average transporters on PD can contribute to reduction in glucose exposure for patients maintained on automated PD and appears to be safe.

Two icodextrin exchanges per day in peritoneal dialysis patients with ultrafiltration failure: one center’s experience and review of the literature

“…Gobin et al [26], who measured blood icodextrin levels in their patients, observed a doubling of the blood level from 345 ± 145 mg/dl to 615 ± 120 mg/dl at 3 months that remained the same at 6 months. Sav et al [27] who measured not only icodextrin blood levels but also maltose levels found a mild increase in the latter, after 3 months that was not statistically significant,.…”

“…Long-term exposure to glucose in PD patients has a number of deleterious effects, such as chronic changes to the peritoneal membrane and systemic metabolic effects. Gobin et al [26] have shown that by using two icodextrin exchanges per day among nine patients over 6 months, they could decrease the patient's glucose exposure from 410 ± 75 to 300 ± 75 g/day. However, the way they used the two exchanges, one for 4-5 h and the other for a 9-10-h dwell, did not achieve extra UF, compared to one long-dwell exchange/day.…”

“…Impaired removal of creatinine by icodextrin should be studied if these changes are duplicated in subsequent studies [26,27].…”

Automated Peritoneal Dialysis Prescriptions for Enhancing Sodium and Fluid Removal: A Predictive Analysis of Optimized, Patient-Specific Dwell Times for the Day Period

“…The infused 2 L of 2.27% glucose solution was drained when T OPT was reached, and the peritoneal cavity was kept dry Table 3, where detailed results are shown for the nighttime and daytime periods separately. 24-HOUR UF Figure 4 shows the predicted 24-hour UF. The reference standard therapy resulted in 621 mL of UF in 24 hours, the lowest among the therapies considered.…”

Bimodal Solutions or Twice-Daily Icodextrin to Enhance Ultrafiltration in Peritoneal Dialysis Patients

“…Recently, the daily use of two ico exchanges has been suggested in order to minimize the glucose load and/or to increase the UF rate [9–12]. …”