Comparison of peritoneal equilibrium test with icodextrin and 2.5% glucose dialysis solutions

Icodextrin provides a different ultrafiltration mechanism than glucose-based dialysate.

To evaluate the difference in the peritoneal equilibrium test (PET) with regard to using icodextrin (Ico-PET) and glucose dialysate we designed a prospective study using Ico-PET and 2 cross-over conventional 2.5% glucose-based dialysate PETs (Gluco 1-PET and Gluco 2-PET) administered 3 months before and after the Ico-PET in 58 chronic peritoneal dialysis patients.

More patients demonstrated higher transport types with the Ico-PET than the Gluco 1-PET and Gluco 2-PET (p<0.001). After a dwell time of 4 hours, the Ico-PET did not show an ultrafiltration benefit compared with the Gluco-PET (272.8 +/- 137.1 mL vs. 348.3 +/- 215.2 mL, p<0.001). The Ico-PET not only showed significantly higher values in the 0-hour, 2-hour and 4-hour dialysate to plasma creatinine concentration ratio (D/P Cr) than those of the Gluco 1-PET (p=0.029 and p<0.001, respectively), but also showed higher values in the 0-hour and 4-hour D/P Cr than those of the Gluco 2-PET (both p<0.001). The total ultrafiltration volume was positively correlated with the 4-hour D/P Cr with the Ico-PET (r=0.41, p=0.001), but the correlation was negative with the Gluco 1-PET (r=-0.33, p=0.012) and Gluco 2-PET (r=-0.51, p<0.001). The ratio of the glucose concentration in the outflow dialysate compared with baseline level (D/Do glucose), was also significantly higher with the Ico-PET than with the Gluco 1-PET and Gluco 2-PET after both 2 and 4 hours (both p<0.001).

The Ico-PET showed a completely different result from the conventional Gluco-PET. The Ico-PET provi-des a superior solute transport and inferior ultrafiltration rates, and the prevalence of high transporters was also increased with the Ico-PET.