Molecular weight of polydisperse icodextrin effects its oncotic contribution to water transport

Icodextrin, a mixture of polysaccharides of alpha-(1 --> 4) polyglucopyranose having 10% branched chains, is clinically available as a D-glucose substitute for peritoneal dialysis (PD). Due to the high intraperitoneal retention time of this glucose polymer (GP), water transport from the vessels to the peritoneal cavity is prolonged even in PD patients with high peritoneal permeability. The purpose of this study was to elucidate why 7.5% icodextrin solution has such a broad distribution of molecular weights. A gel permeation chromatography study indicated that the average molecular weight was about 18.0 kDa in terms of number average (Mn) and 31.3 kDa in terms of weight average (Mw), respectively, resulting in a polydispersity index (Mn/Mw) of 1.74. Five fractions of GP having Mn values of 41.3, 19.3, 8.3, 3.8, and 2.1 kDa, respectively, produced 0.24, 0.49, 0.50, 0.08, and 0.03 mOsmol/kg H2O of colloid osmotic pressure. Water transport through a membrane having a molecular cutoff of 15 kDa was simulated using the mass transfer coefficient and reflection coefficient for each fraction. Fractions with Mn values of 19.3 and 8.3 kDa contributed to water transport dominantly (approximately 76%), while only 18%, 5%, and 3% of total water removal was contributed by fractions with Mn values of 41.3, 3.8 and 2.1 kDa, respectively. As a result of enzymatic degradation for 10 h by 2, 10, or 20 U/l alpha-amylase, a decrease in the high molecular weight zone (40-60 kDa) and a rise in the low molecular weight zone (1-2 kDa) were seen with few change in the distribution profile between 4 and 30 kDa. These results suggested that fractions in the molecular range between 8.3 and 19.3 kDa, where the distribution profile was less influenced by enzymatic degradation, preferably contributed to water transport.