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Recommendations for the use of icodextrin in peritoneal dialysis patients
Author(s) -
JOHNSON DAVID W,
AGAR JOHN,
COLLINS JOHN,
DISNEY ALEX,
HARRIS DAVID CH,
IBELS LLOYD,
IRISH ASHLEY,
SALTISSI DAVID,
SURANYI MICHAEL
Publication year - 2003
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1046/j.1440-1797.2003.00117.x
Subject(s) - icodextrin , medicine , peritoneal dialysis , tonicity , ultrafiltration (renal) , diabetes mellitus , exenatide , urology , dialysis , type 2 diabetes mellitus , type 2 diabetes , endocrinology , chromatography , chemistry
SUMMARY: Icodextrin is a starch‐derived, high molecular weight glucose polymer, which has been shown to promote sustained ultrafiltration equivalent to that achieved with hypertonic (3.86%/4.25%) glucose exchanges during prolonged intraperitoneal dwells (up to 16 h). Patients with impaired ultrafiltration, particularly in the settings of acute peritonitis, high transporter status and diabetes mellitus, appear to derive the greatest benefit from icodextrin with respect to augmentation of dialytic fluid removal, amelioration of symptomatic fluid retention and possible prolongation of technique survival. Glycaemic control is also improved by substituting icodextrin for hypertonic glucose exchanges in diabetic patients. Preliminary in vitro and ex vivo studies suggest that icodextrin demonstrates greater peritoneal membrane biocompatibility than glucose‐based dialysates, but these findings need to be confirmed by long‐term clinical studies. This paper reviews the available clinical evidence pertaining to the safety and efficacy of icodextrin and makes recommendations for its use in peritonal dialysis.