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Peritoneal defense using icodextrin or glucose for daytime dwell in CCPD patients
N Posthuma1, P ter Wee, A J Donker
1Department of Nephrology, Free University Hospital, Amsterdam, The Netherlands.
Objective:
To investigate peritoneal defense during icodextrin use in continuous cyclic peritoneal dialysis (CCPD).
Design:
In an open, prospective, 2-year follow-up study, CCPD patients were randomized to either glucose (Glu) or icodextrin (Ico) for their long daytime dwell.
Setting:
University hospital and teaching hospital.
Patients:
Both established and patients new to CCPD were included. A life expectancy of more than 2 years, a stable clinical condition, and written informed consent were necessary before entry. Patients aged under 18 years, those who had peritonitis in the previous month, and women of childbearing potential, unless taking adequate contraceptive precautions, were excluded. Thirty-eight patients (19 Glu, 19 Ico) started the study. The median follow-up was 16 and 17 months for Glu and Ico respectively (range 0.5-25 months and 5-25 months, respectively).
Outcome Measures:
Peritoneal defense characteristics and peritoneal dialysis-related infections were recorded every 3 months.
Results:
Total peritoneal white cell count tended to decrease over time in both groups. After 1 year, absolute numbers and percentages of effluent peritoneal macrophages (PMphis) were significantly higher in Ico than in Glu patients; this difference in the percentage persisted after 2 years. Percentage of mesothelial cells increased overtime in Ico patients. The phagocytic capacity of PMphis decreased over time, resulting in a borderline significant difference for coagulase-negative staphylococci (p = 0.05) and a significant difference for Escherichia coli (p < 0.05) phagocytosis in favor of Ico patients. PMphi oxidative metabolism remained stable over time without a difference between the groups. PMphi cytokine production and effluent opsonic capacity also remained stable over time. Finally, 16 peritonitis episodes in Glu and 14 in Ico patients occurred. Glucose patients had 37 and Ico patients 32 exit-site infections during the study.
Conclusion:
CCPD patients using Ico did equally as well as Glu-treated patients with respect to clinical infections and most peritoneal defense characteristics. However, in a few peritoneal defense tests, Ico-treated patients did better.