Correlation between peritoneal permeability and ultrafiltration volume with icodextrin-based peritoneal dialysis...

Area of Science:

• Nephrology
• Biomedical Engineering
• Clinical Medicine

Background:

• Continuous ambulatory peritoneal dialysis (CAPD) is a vital treatment for end-stage renal disease.
• Icodextrin is a glucose-free osmotic agent used in peritoneal dialysis (PD).
• Understanding the peritoneal transport characteristics of icodextrin is crucial for optimizing PD therapy.

Purpose of the Study:

• To evaluate the impact of icodextrin-based PD solution on peritoneal transport, specifically ultrafiltration (UF) and dialysate-to-plasma creatinine (D/P(Cr)).
• To assess changes in UF and D/P(Cr) using the peritoneal equilibration test (PET) before and after initiating icodextrin therapy.

Main Methods:

• Eight anuric patients on CAPD using a 2.5% glucose solution were switched to an icodextrin solution for overnight dwells.
• Peritoneal equilibration tests (PET) were conducted before and 12 weeks after the switch to icodextrin.
• UF and D/P(Cr) were measured at various time points after icodextrin and glucose dwells.

Main Results:

• An 8-hour dwell with icodextrin significantly increased UF compared to baseline glucose solution (517.5 mL vs. 356.3 mL, p < 0.001).
• Daily total UF remained unchanged.
• D/P(Cr) significantly increased immediately after icodextrin dwells and after rinsing with glucose solution (p < 0.01).
• D/P(Cr) did not change after an 8-hour glucose dwell, irrespective of prior icodextrin use.

Conclusions:

• Icodextrin enhances ultrafiltration in CAPD patients.
• The elevated D/P(Cr) after icodextrin dwells may indicate an effect on the peritoneal membrane's small pores.
• Performing PETs after a glucose dwell is recommended to avoid confounding effects of icodextrin on creatinine transport measurements.