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Icodextrin |
Department of Clinical Nephrology and Dialysis,1 CHPC Hôpital Louis Pasteur, Cherbourg; Peritoneal Dialysis Unit,2 La Pitié-Salpétrière University Hospital, Paris, France; Department of Nephrology and Dialysis,3 Brugmann University Hospital, Brussels, Belgium; Department of Nephrology and Dialysis,4 CHR Clemenceau, Caen, France; Statistics, Epidemiology and Surveillance,5 Baxter Healthcare Corporation, Round Lake; Renal Division,6 Baxter Healthcare Corporation, McGaw Park, Illinois, USA; Divisions of Baxter Novum and Renal Medicine,7 Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Baxter Renal Division Latin America,8 Mexico City, Mexico
Correspondence to: P. Freida, Department of Clinical Nephrology and Dialysis, CHPC Hôpital Louis Pasteur, rue Trottebec, Cherbourg, 50102 France. p.freida{at}ch-cherbourg.fr
Background: Evidence is accumulating that the
continuous exposure to high glucose concentrations during peritoneal dialysis
(PD) is an important cause of ultrafiltration (UF) failure. The cornerstone of
prevention and treatment of UF failure is reduction of glucose exposure, which
will also alleviate the systemic impact of significant free glucose
absorption. The challenge for the future is to discover new therapeutic
strategies to enhance fluid and sodium removal while diminishing glucose load
and exposure using combinations of available osmotic agents. Objectives: To investigate in patients on automated PD
(APD) with a fast transport pattern whether there is a glucose-sparing
advantage to replacing 7.5% icodextrin (ICO) during the long dwell with a
mixed crystalloid and colloid PD fluid (bimodal UF) in an attempt to promote
daytime UF and sodium removal while diminishing the glucose strength of the
dialysate at night. Design: A 2 parallel arm, 4 month, prospective
nonrandomized study. Setting: PD units or university hospitals in 4 French
and Belgian districts. Results: During the 4-month intervention period, net UF
and peritoneal sodium removal during the long dwell when treated by bimodal UF
was about 2-fold higher than baseline (with ICO). The estimated percent change
(95% confidence interval) from baseline in net daytime UF for the bimodal
solution was 150% (106% – 193%), versus 18% (–7% – 43%) for
ICO (p < 0.001). The estimated percent change from baseline in
peritoneal sodium removal for the bimodal solution was 147% (112% –
183%), versus 23% (–2% – 48%) for ICO (p < 0.001). The
estimated percent change from baseline in UF efficiency (24-hour net UF
divided by the amount of glucose absorbed) was significantly higher
(p < 0.001) when using the bimodal solution was 71%, versus
–5% for ICO. Conclusion: Prescription of bimodal UF during the day
in APD patients offers the opportunity to optimize the long dwell exchange in
a complete 24-hour APD cycle. The current study demonstrated that a bimodal
solution based on the mixing of glucose (2.6%) and icodextrin (6.8%) achieved
the double target of significantly improving UF and peritoneal sodium removal
by exploring a new concept of glucose-sparing PD therapy.
KEY WORDS: Bimodal ultrafiltration; fluid and sodium removal; glucose exposure; glucose sparing.
Received 24 February 2009; accepted 16 June 2009.
This article has been cited by other articles:
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  P. G. Blake NOVEL APPROACHES TO PRESCRIBING ICODEXTRIN Perit. Dial. Int., July 1, 2009; 29(4): 412 - 414. [Full Text] [PDF]
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