Icodextrin as salvage therapy in peritoneal dialysis patients with refractory fluid overloadReport as inadecuate




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BMC Nephrology

, 2:2

First Online: 03 December 2001Received: 19 October 2001Accepted: 03 December 2001

Abstract

BackgroundIcodextrin is a high molecular weight, starch-derived glucose polymer, which is capable of inducing sustained ultrafiltration over prolonged 12–16 hour peritoneal dialysis PD dwells. The aim of this study was to evaluate the ability of icodextrin to alleviate refractory, symptomatic fluid overload and prolong technique survival in PD patients.

MethodsA prospective, open-label, pre-test-post-test study was conducted in 17 PD patients 8 females-9 males, mean age 56.8 ± 2.9 years who were on the verge of being transferred to haemodialysis because of symptomatic fluid retention that was refractory to fluid restriction, loop diuretic therapy, hypertonic glucose exchanges and dwell time optimisation. One icodextrin exchange 2.5 L 7.5%, 12-hour dwell was substituted for a long-dwell glucose exchange each day.

ResultsIcodextrin significantly increased peritoneal ultrafiltration 885 ± 210 ml to 1454 ± 215 ml, p < 0.05 and reduced mean arterial pressure 106 ± 4 to 96 ± 4 mmHg, p < 0.05, but did not affect weight, plasma albumin concentration, haemoglobin levels or dialysate:plasma creatinine ratio. Diabetic patients n = 12 also experienced improved glycaemic control haemoglobin Alc decreased from 8.9 ± 0.7% to 7.9 ± 0.7%, p < 0.05. Overall PD technique survival was prolonged by a mean of 11.6 months 95% CI 6.0–17.3 months. On multivariate Cox proportional hazards analysis, extension of technique survival by icodextrin was only significantly predicted by baseline net daily peritoneal ultrafiltration adjusted HR 2.52, 95% CI 1.13–5.62, p < 0.05.

ConclusionsIcodextrin significantly improved peritoneal ultrafiltration and extended technique survival in PD patients with symptomatic fluid overload, especially those who had substantially impaired peritoneal ultrafiltration.

List of abbreviationsAPDAutomated peritoneal dialysis

CAPDContinuous ambulatory peritoneal dialysis

CCPDContinuous cycling peritoneal dialysis

D:P Cr 4 hDialysate:plasma creatinine ratio at 4 hours

HbA1cGlycated haemoglobin

LDUFLow daily ultrafiltration

NDUFNormal Daily ultrafiltration

PDPeritoneal dialysis

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2369-2-2 contains supplementary material, which is available to authorized users.

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Author: David Wayne Johnson - Mary Arndt - Amanda O-Shea - Rhonda Watt - Jan Hamilton - Kaia Vincent

Source: https://link.springer.com/



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