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COMBINATION OF CRYSTALLOID (GLUCOSE) AND COLLOID (ICODEXTRIN) OSMOTIC AGENTS MARKEDLY ENHANCES PERITONEAL FLUID AND SOLUTE TRANSPORT DURING THE LONG PD DWELL

¹ Department of Nephrology, Louis Pasteur District Hospital, Cherbourg, France;² Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Science, Warsaw, Poland;³ Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden

Correspondence to: P. Freida, Service de Nephrologie, Centre Hospitalier Louis Pasteur, Cherbourg, 50102 France.
p.freida{at}ch-cherbourg.fr

Background: Fluid and sodium removal is often inadequate in peritoneal dialysis patients with high peritoneal solute transport rate, especially when residual renal function is declining.

Method: We studied the effects of using simultaneous crystalloid (glucose) and colloid (icodextrin) osmotic agents on the peritoneal transport of fluid, sodium, and other solutes during 15-hour single-dwell exchanges using 3.86% glucose, 7.5% icodextrin, and a combination fluid with 2.61% glucose and 6.8% icodextrin in 7 prevalent peritoneal dialysis patients with fast peritoneal solute transport rate.

Results: The combination fluid enhanced net ultrafiltration (mean 990 mL) and sodium removal (mean 158 mmol) compared with 7.5% icodextrin (mean net ultrafiltration 462 mL, mean net sodium removal 49 mmol). In contrast, the 3.86% glucose-based solution yielded negligible ultrafiltration (mean -85 mL) and sodium removal (mean 16 mmol). The combination solution resulted in significantly improved urea (+41%) and creatinine (+26%) clearances compared with 7.5% icodextrin.

Conclusion: A solution containing both crystalloid (glucose 2.61%) and colloid (icodextrin 6.8%) osmotic agents enhanced fluid removal by twofold and sodium removal by threefold compared with 7.5% icodextrin solution during a dwell of 15 hours, indicating that such a combination solution could represent a new treatment option for anuric peritoneal dialysis patients with high peritoneal solute transport rate.

KEY WORDS: KEY WORDS:; Ultrafiltration; icodextrin; glucose; sodium.

Received 16 October 2006; accepted 14 December 2006.

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