Single Daily Icodextrin Exchange as Initial and Solitary Therapy

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Peritoneal Dialysis

Background:

• Incremental dialysis involves gradually increasing dialysis doses as residual kidney function declines.
• Incremental peritoneal dialysis (PD) offers lifestyle flexibility and minimizes exposure to glucose and fluid path contaminants.
• This study investigates single daily icodextrin treatments for patients transitioning to end-stage renal disease (ESRD).

Purpose of the Study:

• To assess fluid and solute removal with single daily icodextrin exchanges in patients with varying glomerular filtration rates (GFR).
• To model the efficacy of incremental PD using a 3-pore kinetic model.

Main Methods:

• Simulated single icodextrin exchanges (8-16 hours) with 2- and 2.5-L bag volumes.
• Assessed different patient transport types (high to low).
• Predicted daily peritoneal ultrafiltration (UF), sodium removal, and weekly total Kt/V (Kt/V_Total) for GFRs from 0 to 15 mL/min/1.73 m².

Main Results:

• Daily peritoneal UF ranged from 359-607 mL; sodium removal ranged from 52-87 mEq, independent of transport type.
• Most patients (except very large) predicted to achieve adequate dialysis (Kt/V_Total ≥ 1.7) with GFR of 10 mL/min/1.73 m².
• Smaller patients achieved adequate dialysis with GFR as low as 6 mL/min/1.73 m².

Conclusions:

• A single daily icodextrin exchange can be customized to enhance urea, UF, and sodium removal in patients with sufficient residual kidney function (RKF).
• This approach may serve as a reasonable initial therapy for incident ESRD patients.