International Icodextrin Use and Association with Peritoneal Membrane Function, Fluid Removal, Patient and Technique...

Area of Science:

• Nephrology
• Internal Medicine
• Clinical Trials

Background:

• Icodextrin is recognized for fluid management benefits in peritoneal dialysis (PD).
• International prescription practices and clinical outcome associations of icodextrin are not well-defined.

Purpose of the Study:

• To describe international icodextrin prescription patterns in PD.
• To investigate the relationship between icodextrin use and clinical outcomes, including mortality and transfer to hemodialysis.

Main Methods:

• Analysis of data from the prospective, international Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).
• Instrumental variable approach and Cox regression were used to assess the association of icodextrin use with death and hemodialysis transfer, adjusted for multiple covariates.
• Data collected from Australia/New Zealand, Canada, Japan, the United Kingdom, and the United States.

Main Results:

• Icodextrin was prescribed in 35% of 5617 patients, with significantly lower use in the United States (17%) compared to other countries.
• Patients on icodextrin had more comorbidities but achieved equivalent ultrafiltration compared to those on glucose solutions.
• Icodextrin use showed no significant association with mortality (HR=1.03) or transfer to hemodialysis (HR=1.2).

Conclusions:

• Significant national and center-level variations exist in icodextrin prescription for PD.
• Icodextrin use is associated with reduced use of hypertonic glucose and equivalent ultrafiltration.
• The findings suggest that while icodextrin may not confer a survival advantage, it offers an alternative for fluid management in PD.