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Perit Dial Int 27(3): 260-266 2007
© 2007 International Society for Peritoneal Dialysis
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Clinical

USE OF ICODEXTRIN DURING NOCTURNAL AUTOMATED PERITONEAL DIALYSIS ALLOWS SUSTAINED ULTRAFILTRATION WHILE REDUCING THE PERITONEAL GLUCOSE LOAD: A RANDOMIZED CROSSOVER STUDY

Ana Rodríguez-Carmona1, Miguel Pérez Fontán2, Elvia García López3, Teresa García Falcón1 and Helena Díaz Cambre1

1 Division of Nephrology, Hospital Juan Canalejo, A Coruña; 2 Department of Medicine, Health Science Institute, University of A Coruña, Spain;3 Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institutet, Huddinge, Stockholm, Sweden

Correspondence to: M. Pérez Fontán, Division of Nephrology, Hospital Juan Canalejo, Xubias 84, A Coruña, Spain.
mfontan{at}canalejo.org

{diamondsuit} Background: Optimization of ultrafiltration and preservation of the peritoneal membrane are desirable objectives in peritoneal dialysis (PD) patients. Mixtures of glucose- and non-glucose-based solutions may help to meet both targets simultaneously.

{diamondsuit} Aim: To analyze the effects, in terms of ultrafiltration and peritoneal glucose load, of including icodextrin-based dialysate in the nocturnal schedule of patients undergoing automated PD (APD).

{diamondsuit} Method: Following a randomized crossover design, 17 APD patients underwent two 10-day study periods under identical prescription (including amino acid-based solution for the night schedule), except for the substitution of 2 L glucose-based dialysate in the nocturnal mixture (control) by a similar amount of icodextrin-based dialysate (icodextrin phase) in one period. Dependent variables included ultrafiltration, sodium removal, peritoneal glucose load, and residual renal function. We measured serum and urine levels of icodextrin metabolites at the end of each phase.

{diamondsuit} Results: Ultrafiltration was marginally higher during the icodextrin phase (median 815 vs 763 mL/day, p = 0.07), while peritoneal sodium removal was similar in both phases (74 vs 71 mmol/L/day). Peritoneal glucose load (median 67.5 vs 104.0 g/day, p < 0.005) and absorption (14.0 vs 35.6 g/day, p < 0.005) were lower during the icodextrin phase. Diuresis was also modestly lower during the icodextrin phase (500 vs 600 mL/day, p < 0.05). Serum levels of icodextrin metabolites were moderately higher in the icodextrin phase (p < 0.005) in patients both on and off diurnal icodextrin.

{diamondsuit} Conclusion: Inclusion of amino acid- and icodextrin-based solutions in the nocturnal schedule of APD patients may allow sustained ultrafiltration and sodium removal while significantly reducing the peritoneal glucose load in these patients.

KEY WORDS: KEY WORDS:; Icodextrin; amino acid-based solution; automated peritoneal dialysis; ultrafiltration; sodium removal; glucose load; glucose absorption.

Received 16 September 2006; accepted 2 January 2007.






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