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Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients: Results of a Double-Blind Randomized Controlled Trial

Simon J. Davies^*, Graham Woodrow, Kieron Donovan, Jörg Plum, Paul Williams^||, Ann Catherine Johansson^¶, Hans-Peter Bosselmann^#, Olof Heimbürger^**, Ole Simonsen, Andrew Davenport, Anders Tranaeus and Jose C. Divino Filho

*University Hospital of North Staffordshire, Stoke-on-Trent, England; Leeds Teaching Hospitals Trust, Leeds, England; Morriston Hospital, Swansea, Wales; Klinik für Nephrologie, Düsseldorf, Germany; ^||Addenbrookes Hospital, Cambridge, England; ^¶Sahlgrenska Sjukhuset, Goteborg, Sweden; ^#Otto-von-Guericke-Universität, Magdeburg, Germany; **Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden; University Hospital of Lund, Sweden; Royal Free Hospital, London, England; and Baxter S.A., Brussels, Belgium.

Dr. Simon J. Davies, Department of Nephrology, North Staffordshire Hospital, Princes Road, Hartshill, Stoke-on-Trent, ST4 7LN, England. Phone: 01782-554164; Fax: 01782-620759;

ABSTRACT. Worsening fluid balance results in reduced technique and patient survival in peritoneal dialysis. Under these conditions, the glucose polymer icodextrin is known to enhance ultrafiltration in the long dwell. A multicenter, randomized, double-blind, controlled trial was undertaken to compare icodextrin versus 2.27% glucose to establish whether icodextrin improves fluid status. Fifty patients with urine output <750 ml/d, high solute transport, and either treated hypertension or untreated BP >140/90 mmHg, or a requirement for the equivalent of all 2.27% glucose exchanges, were randomized 1:1 and evaluated at 1, 3, and 6 mo. Members of the icodextrin group lost weight, whereas the control group gained weight. Similar differences in total body water were observed, largely explained by reduced extracellular fluid volume in those receiving icodextrin, who also achieved better ultrafiltration and total sodium losses at 3 mo (P < 0.05) and had better maintenance of urine volume at 6 mo (P = 0.039). In patients fulfilling the study’s inclusion criteria, the use of icodextrin, when compared with 2.27% glucose, in the long exchange improves fluid removal and status in peritoneal dialysis. This effect is apparent within 1 mo of commencement and was sustained for 6 mo without harmful effects on residual renal function. E-mail: SimonDavies1@compuserve.com

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