Icodextrin Simplifies PD Therapy by Equalizing UF and Sodium Removal Among Patient Transport Types During Long...

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Biomedical Engineering

Background:

• Peritoneal dialysis (PD) adequacy has shifted focus from small solute clearance to volume control.
• Improving fluid and sodium removal in PD patients remains a key clinical objective.
• This study investigates PD fluid and solute removal using glucose-based and icodextrin solutions.

Purpose of the Study:

• To theoretically predict fluid and solute removal in automated PD (APD) and continuous ambulatory PD (CAPD) using a modified 3-pore model.
• To compare the efficacy of glucose-based versus icodextrin solutions across various patient transport characteristics.
• To evaluate the impact of icodextrin on ultrafiltration and sodium removal efficiencies.

Main Methods:

• Simulations were conducted for day and night dialysis periods using APD and CAPD.
• Varied dwell times and number of exchanges (APD: 3-7 night exchanges).
• Calculated ultrafiltration (UF), sodium removal (NaR), carbohydrate absorption (CHO), UF efficiency (UFE), and NaR efficiency (NaRE) for fast, average, and slow transport patients.

Main Results:

• Significant differences in UF and NaR between fast and slow transporters were observed with glucose solutions.
• Icodextrin use minimized UF and NaR differences between transport types, especially during long APD dwells.
• Icodextrin resulted in greater carbohydrate absorption but improved UF and NaR efficiencies for most patients compared to glucose.

Conclusions:

• Icodextrin minimizes the dependence of fluid and sodium removal on patient transport type in APD and CAPD.
• This simplification improves fluid and sodium removal efficiencies in fast and average transporters without increased glucose exposure.
• Icodextrin offers a more predictable approach to PD adequacy, particularly for volume control.