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Superiority of Icodextrin Compared with 4.25% Dextrose for Peritoneal Ultrafiltration

Fredric Finkelstein^*, Helen Healy, Ali Abu-Alfa^*, Suhail Ahmad, Fiona Brown, Todd Gehr^||, Kevin Nash^¶, Michael Sorkin^# and Salim Mujais^# on behalf of the Icodextrin High Transporter Trial Group

^* Yale University School of Medicine, New Haven, Connecticut; Royal Brisbane Hospital, Herston, Queensland, Australia; University of Washington, Seattle, Washington; Monash Medical Center, Clayton, Victoria, Australia; ^|| Virginia Commonwealth University, Richmond, Virginia; ^¶ Evanston Northwestern Healthcare, Evanston, Illinois; and ^# Renal Division, Baxter Healthcare Corporation, McGaw Park, Illinois

Address correspondence to: Dr. Salim Mujais, Renal Division, Baxter Healthcare Corporation, 1620 Waukegan Road, MPGR-A2E, McGaw Park, IL 60085-9815. Phone: 847-473-6349; Fax: 847-473-6959; E-mail: salim_mujais{at}baxter.com

Several clinical observations suggest the superiority of icodextrin compared with 4.25% dextrose in optimizing peritoneal ultrafiltration (UF), but no rigorous controlled evaluation has hitherto been performed. For comparing icodextrin and 4.25% dextrose during the long dwell of automated peritoneal dialysis, a multicenter, randomized, double-blind trial was conducted in 92 patients (control, 45; icodextrin, 47) with 4-h dialysate to plasma ratio creatinine >0.70 and D/D₀ glucose <0.34. Long-dwell net UF and the UF efficiency ratio (net UF volume per gram of dialysate carbohydrate absorbed) were determined at baseline, week 1, and week 2. The control and treatment groups were comparable at baseline (all patients using 4.25% dextrose for the long dwell) with regard to mean (±SEM) net UF (201.7 ± 103.1 versus 141.6 ± 75.4 ml, respectively; P = 0.637) and the percentage of patients with negative net UF (control, 37.8%; treatment, 42.6%; P = 0.641). During the study period, net UF was unchanged from baseline in the control group but increased significantly (P < 0.001) in the icodextrin group from 141.6 ± 75.4 to 505.8 ± 46.8 ml at week 1 and 540.2 ± 46.8 ml at week 2. In the icodextrin group, the incidence of negative net UF was significantly lower (P < 0.0001) than in the control group. Findings were similar for UF efficiency ratio. Rash was reported significantly more often in the icodextrin group. This study showed that in high-average and high transporters, icodextrin is superior to 4.25% dextrose for long-dwell fluid and solute removal.

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				A. Vychytil, C. Remon, C. Michel, P. Williams, A. Rodriguez-Carmona, B. Marron, E. Vonesh, S. van der Heyden, J. C. D. Filho, and on behalf of the Extraneal Peritonitis Study Group Icodextrin does not impact infectious and culture-negative peritonitis rates in peritoneal dialysis patients: a 2-year multicentre, comparative, prospective cohort study Nephrol. Dial. Transplant., November 1, 2008; 23(11): 3711 - 3719. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673