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Icodextrin |
Unidad de Investigación Médica en Enfermedades Nefrológicas,1 Hospital de Especialidades, Centro Médico Nacional Siglo XXI; Hospital General de Zona 27,2 Hospital General de Zona 47,3 Hospital General de Zona 8,4 Hospital General de Zona 25,5 Instituto Mexicano del Seguro Social, México City, México
Correspondence to: R. Paniagua, Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Av. Cuauhtemoc 330, Col. Doctores, México, D.F., C.P. 06725, México. jpaniaguas{at}cis.gob.mx; ramon.paniagua{at}imss.gob.mx
Background: Icodextrin-based solutions (ICO) have
clinical and theoretical advantages over glucose-based solutions (GLU) in
fluid and metabolic management of diabetic peritoneal dialysis (PD) patients;
however, these advantages have not yet been tested in a randomized
fashion. Objective: To analyze the effects of ICO on metabolic
and fluid control in high and high-average transport diabetic patients on
continuous ambulatory PD (CAPD). Patients and Methods: A 12-month, multicenter,
open-label, randomized controlled trial was conducted to compare ICO
(n = 30) versus GLU (n = 29) in diabetic CAPD patients with
high-average and high peritoneal transport characteristics. The basic daily
schedule was 3 x 2 L GLU (1.5%) and either 1 x 2 L ICO (7.5%) or 1
x 2 L GLU (2.5%) for the long-dwell exchange, with substitution of 2.5%
or 4.25% for 1.5% GLU being allowed when clinically necessary. Variables
related to metabolic and fluid control were measured each month. Results: Groups were similar at baseline in all
measured variables. More than 66% of the patients using GLU, but only 9% using
ICO, needed prescriptions of higher glucose concentration solutions.
Ultrafiltration (UF) was higher (198 ± 101 mL/day, p <
0.05) in the ICO group than in the GLU group over time. Changes from baseline
were more pronounced in the ICO group than in the GLU group for extracellular
fluid volume (0.23 ± 1.38 vs –1.0 ± 1.48 L, p
< 0.01) and blood pressure (systolic 1.5 ± 24.0 vs –10.4
± 30.0 mmHg, p < 0.01; diastolic 1.5 ± 13.5 vs
–6.2 ± 14.2 mmHg, p < 0.01). Compared to baseline,
patients in the ICO group had better metabolic control than those in the GLU
group: glucose absorption was more reduced (–17 ± 44 vs –64
± 35 g/day) as were insulin needs (3.6 ± 3.4 vs – 9.1
± 4.7 U/day, p < 0.01), fasting serum glucose (8.3 ±
36.5 vs –37 ± 25.8 mg/dL, p < 0.01), triglycerides
(54.5 ± 31.9 vs –54.7 ± 39.9 mg/dL, p < 0.01),
and glycated hemoglobin (0.79% ± 0.79% vs –0.98% ± 0.51%,
p < 0.01). Patients in the ICO group had fewer adverse events
related to fluid and glucose control than patients in the GLU group. Conclusion: Icodextrin represents a significant
advantage in the management of high transport diabetic patients on PD,
improving peritoneal UF and fluid control and reducing the burden of glucose
overexposure, thereby facilitating metabolic control.
KEY WORDS: Icodextrin; diabetes; ultrafiltration; extracellular fluid volume; metabolic control; randomized controlled trial.
Received 8 May 2008; accepted 17 November 2008.
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