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Clinical experience with icodextrin in children: ultrafiltration profiles and metabolism
A W de Boer1, C H Schröder, R van Vliet
1Department of Pediatrics, University Hospital Nijmegen, The Netherlands.
Insights
Seven-percent-five icodextrin provides sustained ultrafiltration in children during 12-hour peritoneal dialysis dwells, comparable to 3.86% glucose. Icodextrin and its metabolites reach steady-state levels within two weeks and are undetectable four weeks post-study.
Area of Science:
- Pediatric Nephrology
- Peritoneal Dialysis
- Biomaterials
Background:
- Icodextrin is used in adults for sustained ultrafiltration (UF) in long-term peritoneal dialysis (PD) dwells.
- Limited data exists on the efficacy and metabolism of icodextrin in pediatric PD patients.
Purpose of the Study:
- To evaluate the ultrafiltration (UF) and metabolic profile of 7.5% icodextrin in pediatric patients undergoing PD.
- To compare the UF performance of icodextrin with glucose solutions in children.
Main Methods:
- Eleven pediatric patients received 12-hour daytime dwells with 7.5% icodextrin.
- Ultrafiltration (UF) volumes were measured and compared to baseline glucose solutions (1.36% and 3.86%).
- Icodextrin and metabolite levels (maltose, maltotriose, maltotetraose) were monitored over six weeks.
Main Results:
- Net UF with icodextrin was comparable to 3.86% glucose and significantly higher than 1.36% glucose.
- Icodextrin increased weekly Kt/V by 0.52.
- Steady-state levels of icodextrin and its metabolites were achieved by week two and were undetectable four weeks after study completion.
Conclusions:
- 7.5% icodextrin effectively maintains ultrafiltration during 12-hour dwells in children, performing similarly to 3.86% glucose.
- Icodextrin demonstrates a favorable metabolic profile in pediatric patients, with predictable steady-state levels and clearance.
Abstract:
Icodextrin use in adults provides sustained ultrafiltration (UF) in long-term dwells. No information is available on UF and metabolism in children. In 11 children, a volume of 1,049+/-138 ml/m2 of the study fluid (1.36% glucose, 7.5% icodextrin, 3.86% glucose) was administered for 12 h. Net UF with icodextrin (339+/-147 ml/1.73 m2) did not differ from UF with 3.86% glucose (450+/-306 ml/1.73 m2, P=0.53) and was higher than UF with 1.36% glucose (-87+/-239 ml/1.73 m2, P=0.003). Icodextrin added 0.52+/-0.07 to the weekly Kt/V. Over 6 weeks, icodextrin was used for 12-h daytime dwell. Total icodextrin reached a steady-state level of 2.91+/-1.22 g/l at 2 weeks. The main icodextrin metabolites were maltose, maltotriose, and maltotetraose. After 2 weeks, steady state levels were 2.02+/-0.66 mmol/l, 1.46+/-0.35 mmol/l, and 0.45+/-0.12 mmol/l. No icodextrin or metabolites were detectable 4 weeks after the study. We conclude that 7.5% icodextrin is capable of maintaining UF during 12-h dwell in children and is comparable to UF obtained with 3.86% glucose. Steady-state levels of icodextrin and metabolites were reached at 2 weeks and disappeared after the study.