Icodextrin dialysate significantly boosts ultrafiltration and dialysis adequacy in peritoneal dialysis patients

Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) often face challenges with long-term glucose-based solutions, including fluid overload, inflammation, and metabolic complications. These issues can lead to inadequate dialysis, malnutrition, and increased cardiovascular risk, ultimately impacting patient quality of life and survival. There is a critical need for alternative dialysates that can enhance ultrafiltration and improve clinical outcomes without exacerbating these problems. Icodextrin, a glucose polymer, is designed for longer dwell times, offering a potential solution to these limitations by facilitating sustained osmotic ultrafiltration.

This prospective, single-arm, self-controlled observational study enrolled 50 peritoneal dialysis patients. Each participant first received a standard glucose-based peritoneal dialysis solution for 6 months, followed by 6 months of treatment with an icodextrin-based solution for overnight dwell. The primary endpoints included changes in 24-h ultrafiltration volume, Kt/V (a measure of dialysis adequacy), serum albumin, hemoglobin, C-reactive protein (CRP), and B-type natriuretic peptide (BNP) levels. Safety was assessed by monitoring for severe adverse events throughout the study period.

Compared to the standard glucose-based solution phase, the subsequent 6-month icodextrin regimen significantly improved several key clinical parameters. Significant increases were observed in 24-h ultrafiltration volume, Kt/V, serum albumin levels, and hemoglobin levels. Conversely, C-reactive protein (CRP) and B-type natriuretic peptide (BNP) levels significantly decreased (p < 0.05). There was also a significant difference in the distribution of 24-h urine volume (p < 0.0001), indicating improved fluid balance. Importantly, no severe adverse events were reported, demonstrating a satisfactory safety profile. This suggests icodextrin effectively addresses multiple complications associated with conventional PD solutions.

Overnight icodextrin use significantly enhanced ultrafiltration, dialysis adequacy, and improved markers of inflammation, fluid overload, anemia, and malnutrition.