Use of icodextrin solution to evaluate peritoneal transport capacity

Area of Science:

• Nephrology
• Peritoneal Dialysis
• Biomaterials Science

Background:

• The Peritoneal Equilibration Test (PET) is standard for assessing peritoneal transport.
• Measuring drain volume after a 4-hour dwell with 4.25% glucose can indicate ultrafiltration failure.

Purpose of the Study:

• To evaluate if measuring drained volume after a 4-hour dwell with 7.5% icodextrin (ICO) correlates better with PET parameters than 4.25% glucose.
• To determine the predictive value of ICO dwell for peritoneal transport.

Main Methods:

• 35 peritoneal dialysis patients underwent three procedures: standard PET, 4-hour dwell with 4.25% glucose, and 4-hour dwell with 7.5% ICO.
• Drain volumes were measured and correlated with PET parameters like D4/D0 ratio and D/PCr ratio.

Main Results:

• ICO ultrafiltration volume was greater in high transporters and correlated significantly with D4/D0 ratio (r=-0.579, P=0.002) and D/PCr ratio (r=0.474, P=0.002).
• ICO showed higher predictive accuracy (AUC 0.867 for D/PCr, 0.792 for D4/D0) compared to 4.25% glucose (AUC 0.738 for D/PCr, 0.710 for D4/D0).
• A 141 mL cut-off volume using ICO effectively distinguished high/high-average transporters from low/low-average transporters.

Conclusions:

• Drain volume after a 4-hour dwell with 7.5% icodextrin is a superior predictor of peritoneal transport patterns compared to 4.25% glucose.
• This ICO method offers a simpler and effective alternative for assessing peritoneal function in dialysis patients.