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Published on: May 2, 2018
Icodextrin and intraperitoneal inflammation.
Misaki Moriishi1, Hideki Kawanishi
1Tsuchiya General Hospital, Hiroshima, Japan. usagi@tsuchiya-hp.jp
Summary
Icodextrin peritoneal dialysis fluid may cause inflammation in the peritoneum, increasing peritoneal permeability and inflammatory markers. Reverting to glucose dialysis solution reduced these effects in most patients, but not all.
Area of Science:
- Nephrology
- Peritoneal Dialysis
- Inflammation Biology
Background:
- Peritoneal dialysis (PD) solutions can impair the peritoneum.
- Icodextrin-based PD fluid (PDF) has been suspected of inducing intraperitoneal inflammation due to its cornstarch origin.
Purpose of the Study:
- To investigate icodextrin PDF-induced intraperitoneal inflammation.
- To assess changes in peritoneal permeability and inflammatory markers after switching between glucose and icodextrin PDF.
Main Methods:
- Study included 7 stable PD patients switched from glucose PDF to icodextrin PDF, then back to glucose PDF after 30 months.
- Evaluated peritoneal permeability using peritoneal equilibrium test (PET) and measured dialysate-to-plasma (D/P) ratios of creatinine, beta2-microglobulin, albumin, IgG, and alpha2-macroglobulin.
- Assessed inflammatory markers (interleukin-6) and fibrinolysis/coagulation markers (fibrinogen degradation products) in overnight effluent.
Main Results:
- Switching to icodextrin PDF significantly elevated fibrinogen degradation products and increased D/P ratios for creatinine, beta2-microglobulin, and albumin.
- In most patients, switching back to glucose PDF reduced these markers, but 2 patients showed persistent elevations, with one developing pre-EPS and the other requiring hemodialysis.
Conclusions:
- Icodextrin dialysis solution may induce peritoneal inflammation.
- Long-term use of icodextrin PDF requires further investigation due to potential inflammatory effects.
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