OBJECTIVE: To review all clinical studies and experience gained with icodextrin to date; primarily its use in peritoneal dialysis in patients with end-stage renal failure, but also its use as an intraperitoneal vehicle. DATA SOURCES: Peer-reviewed original research articles in the literature; abstracts from international scientific meetings; data generated from the compassionate use programme. STUDY SELECTION: All published studies to date are included, some 10-20 studies being included in this review. DATA EXTRACTION: Data have not been specifically extracted from studies; results have been described in the context of overall experience. RESULTS: Over ten years of clinical experience with icodextrin have now been accumulated, in both continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). A small number of patients have received icodextrin for over five years, with no loss of effect. Icodextrin produces sustained ultrafiltration over long dwells while being iso-osmolar, by the process of colloid osmosis. CONCLUSIONS: Icodextrin represents the first viable alternative osmotic agent to glucose, for use in solutions for peritoneal dialysis. It also has a potential use as a vehicle solution for intraperitoneal drug delivery.

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