Icodextrine peritoneal dialysis solution in clinical practice
Authors:
S. Opatrná
Authors place of work:
I. interní klinika Lékařské fakulty UK a FN Plzeň, přednosta doc. MUDr. Martin Matějovič, Ph. D.
Published in the journal:
Vnitř Lék 2008; 54(12): 1155-1160
Category:
Reviews
Summary
Icodextrin, a glucose polymer, is an alternative osmotic agent to glucose in peritoneal dialysis solutions. Icodextrin generates ultrafiltration through colloid osmosis and is thus effective even during long‑term (e. g., nighttime) dwells and in cases of high peritoneal permeability, where it prevents dialysate reabsorption into the systemic circulation. Ultrafiltration is maintained even in the presence of peritonitis. The incidence of bacterial peritonitis is not different when using icodextrin‑ or glucose‑based solutions. Some time ago, icodextrin use was implicated in an increased incidence of sterile peritonitis. This was due to contamination of some batches of the solution by peptidoglycan present in the cell wall of G+ bacteria. Using exact isotope methods, treatment with icodextrin‑based solution has been shown to improve the hydration status of peritoneal dialysis patients, suggesting a potential for improved blood pressure control. Icodextrin‑based dialysis is associated with a reduction of left ventricular mass. Given the methodological flaws of trials conducted to date, the acute hemodynamic effects of icodextrin cannot be conclusively interpreted. Inclusion of icodextrin‑based solution instead of the glucose‑based one into the prescription of peritoneal dialysis decreases the metabolic load with glucose potentially having a beneficial effect on hyperlipidemia, hyperinsulinemia and hyperleptinemia, with improved glycemic control in patients with diabetes as an additional benefit. Function of the peritoneum as a dialysis membrane is stable during icodextrin‑based treatment, possibly longer compared with glucose‑based solutions. Data derived from a large-scale registry have shown lower mortality of icodextrin‑treated patients; this, however, needs to be confirmed by prospective randomized controlled trials.
Key words:
peritoneal dialysis fluid – icodextrin – peritoneal dialysis – ultrafiltration
Zdroje
1. Hain H, Kessel M. Aspects of new solutions for peritoneal dialysis. Nephrol Dial Transplant 1987; 2: 67–72.
2. Kopple JD, Bernard D, Messana J et al. Treatment of malnourished CAPD patients with an amino acid based dialysate. Kidney Int 1995; 47: 1148–1157.
3. Mistry CD, Gokal R, Peers E et al. A randomized multicenter clinical trial comparing isosmolar Icodextrin with hyperosmolar glucose solutions in CAPD. Kidney Int 1994; 46: 496–503.
4. Finkelstein F, Healy H, Abu-Alfa A et al. Superiority of Icodextrin Compared with 4.25% Dextrose for Peritoneal Ultrafiltration. J Am Soc Nephrol 2005; 16: 546–554.
5. Araújo MRT, Pecoits-Filho RFS, Junior JER et al. The relationship between ultrafiltrate volume with icodextrin and peritoneal transport pattern according to the peritoneal equilibration test. Perit Dial Int 2002; 22: 229–233.
6. Wolfson M, Piraino B, Hamburger R et al. A Randomized Controlled Trial to Evaluate the Efficacy and Safety of Icodextrin in Peritoneal Dialysis. Am J Kidney Dis 2002; 5: 1055–1065.
7. Mujais S. Microbiology and outcome of peritonitis in North America. Kidney Int Suppl 2006; 103: S55–S62.
8. Dombros N, Dratwa M, Feriani M et al. European best practice guidelines for peritoneal dialysis. 3 Peritoneal access. Nephrol Dial Transplant 2005; 20 (Suppl 9): ix8–ix12.
9. Opatrná S. Can be incidence of peritonitis associated with peritoneal dialysis further decreased? Vnitř Lék 2004; 50: 578–581.
10. Hájková B, Fixa P. The latest trends in the treatment peritonitis of the patients on peritoneal dialysis. Vnitř Lék 2004; 50: 619–623.
11. Opatrná S, Klaboch J. Specific aspects of peritoneal dialysis in diabetic patients. Vnitř Lék 2008; 54: 523–529.
12. Posthuma N, ter Wee PM, Verbrugh HA et al. Icodextrin use in CCPD patients during peritonitis: ultrafiltration and serum disaccharide concentrations. Nephrol Dial Transplant 1998; 13: 2341–2344.
13. Konings CJAM, Kooman JP, Schonck M et al. Fluid status, blood pressure, and cardiovascular abnormalities in patients on peritoneal dialysis. Perit Dial Int 2002; 22: 477–487.
14. Woodrow G, Stables G, Oldroyd B et al. Comparison of icodextrin and glucose solutions for the daytime dwell in automated peritoneal dialysis. Nephrol Dial Transplant 1999; 14: 1530–1535.
15. Davies SJ, Woodrow G, Donovan K et al. Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients: Results of a Double-Blind Randomized Controlled Trial. J Am Soc Nephrol 2003; 14: 2338–2344.
16. Konings CJAM, Kooman JP, Schonck M et al. Effect of icodextrin on volume status, blood pressure and echocardiographic parameters: A randomized study. Kidney Int 2003; 63: 1556–1563.
17. Selby NM, Fonseca S, Hulme L et al. hypertonic glucose‑based peritoneal dialysate is associated with higher blood pressure and adverse hemodynamics as compared with icodextrin. Nephrol Dial Transplant 2005; 20: 1848–1853.
18. Woods HF. Icodextrin and haemodynamics. Nephrol Dial Transplant 2006; 21: 820.
19. Marshall J, Jennings P, Scott A et al. Glycemic control in diabetic CAPD patients assessed by continusou glucose monitoring system (CGMS). Kidney Int 2003; 64: 1480–1486.
20. Babazono T, Nakamoto H, Kasai K et al. Effects of Icodextrin on Glycemic and Lipid Profiles in Diabetic Patients Undergoing Peritoneal Dialysis. Am J Nephrol 2007; 27: 409–415.
21. Gursu EM, Ozdemir A, Yalinbas B et al. The effect of icodextrin and glucose‑containing solutions on insulin resistance in CAPD patients. Clin Nephrol 2006; 66: 263–268.
22. Canbakan M, Sahin GM. Icodextrine and Insulin Resistance in Continuous Ambulatory Peritoneal Dialysis Patients. Ren Fail 2007; 29: 289–293
23. Amici G, Orrasch M, da Rin GD et al. Hyperinsulinism Reduction Associated with Icodextrin Treatment in Continuous Ambulatory Peritoneal Dialysis Patients. Adv Perit Dial 2001; 17: 80–83.
24. Opatrná S, Racek J, Stehlík P et al. Effect of a dialysis solution with icodextrin on ultrafiltration and selected metabolic parameters in patients treated with peritoneal dialysis. Čas Lék Čes 2002; 141: 281–285.
25. Kanbay M, Bavbed N, Delibasi T et al. Effect of Peritoneal Dialysis Solution Type on Serum Lipid Levels in End‑Stage Renal Disease. Ren Fail 2007; 29: 309–313.
26. Martikainen T, Teppo AM, Gron-hagen-Riska C et al. Benefit of glucose‑free dialysis solutions on glucose and lipid metabolism in peritoneal dialysis patients. Blood Purif 2005; 23: 303–310.
27. Bredie SJ, Bosch FH, Demacker PN et al. Effects of peritoneal dialysis with an overnight icodextrin dwell on parameters of glucose and lipid metabolism. Perit Dial Int 2001; 21: 275–281.
28. Hithaishi C, Lobbedez T, Padmanabhan S et al. No beneficial effect of icodextrin on blood glucose control. Perit Dial Int 2004; 24: 199–200.
29. Gradden CW, Ahmad R, Bell GM. Peritoneal dialysis: new developments and new problems. Diabet Med 2001; 18: 360–363.
30. Segal KR, Landt M, Klein S. Relationship between insulin sensitivity and plasma leptin concentration in lean and obese men. Diabetes 1996; 45: 988–991.
31. Hotta K, Funahashi T, Arita Y et al. Plasma concentrations of a novel, adipose‑specific protein, adiponectin, in type 2 diabetic patients. Arterioscler Thromb Vasc Biol 2000; 20: 1595–1599.
32. Huang JW, Yen CJ, Chiang HW et al. Adiponectin in peritoneal dialysis patients: a comparison with hemodialysis patients and subjects with normal renal function. Am J Kidney Dis 2004; 43: 1047–1055.
33. Zoccali C, Mallamaci F, Tripepi G et al. Adiponectin, metabolic risk factors, and cardiovascular events among patients with end‑stage renal disease. J Am Soc Nephrol 2002; 13: 134–141.
34. Opatrná S, Opatrný K Jr, Racek J et al. Effect of Icodextrin‑Based Dialysis Solution on Peritoneal Leptin Clearance. Perit Dial Int 2003; 23: 89–91.
35. Furuya R, Odamaki M, Kumagai H et al. Beneficial effects of icodextrin on plasma level of adipocytokines in peritoneal dialysis patients. Nephrol Dial Transplant 2006; 21: 494–498.
36. Tintillier M, Pochet JM, Christophe JL et al. Transient sterile chemical peritonitis with icodextrin: clinical presentation, prevalence, and literature review. Perit Dial Int 2002; 22: 534–537.
37. Martis L, Patel M, Giertych JBS et al. Aseptic peritonitis due to peptidoglycan contamination of pharmacopoeia standard dialysis solution. The Lancet 2005; 365: 588–594.
38. Davies SJ, Brown EA, Frandsen NE et al. Longitudinal membrane function in functionally anuric patients treated with APD: Data from EAPOS on the effects of glucose and icodextrin prescription. Kidney Int 2005; 67: 1609–1615.
39. Kuriyama R, Tranaeus A, Idegami T. Icodextrin reduces mortality and the drop-out rate in Japanese peritoneal dialysis patients. Adv Perit Dial 2006; 22: 108–110.
Štítky
Diabetology Endocrinology Internal medicineČlánok vyšiel v časopise
Internal Medicine
2008 Číslo 12
Najčítanejšie v tomto čísle
- New evidence‑based criteria for evaluating the appropriateness of drug regimen in seniors. Criteria STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment)
- Schnitzler syndrome – report on a fourteen-year course of the disease and an overview of information on the disease
- Giant cell arteritis manifested by bilateral arteritic Anterior Ischaemic Optic Neuropathy (AION)
- Guidelines for the treatment of invasive candidiasis