Can one long peritoneal dwell with icodextrin replace two short dwells with glucose?

Area of Science:

• Nephrology
• Biomedical Engineering
• Pharmacology

Background:

• Peritoneal dialysis (PD) solutions are crucial for fluid and solute management in patients with kidney failure.
• Glucose-based solutions are standard but can lead to faster osmotic gradient dissipation.
• Icodextrin-based solutions offer a slower osmotic gradient dissipation, potentially improving ultrafiltration (UF).

Purpose of the Study:

• To investigate the efficacy of replacing glucose-based exchanges with icodextrin in PD.
• To compare fluid and solute removal between icodextrin and glucose solutions under various PD schedules.
• To evaluate the impact of different peritoneal solute transfer rates (PSTRs) on the performance of icodextrin.

Main Methods:

• Numerical simulations using a three-pore model incorporating icodextrin hydrolysis.
• Evaluation of ultrafiltration (UF), absorbed glucose (AbsGluc), absorbed carbohydrates (AbsCHO), and ultrafiltration efficiency (UFE).
• Assessment of removed sodium (ReNa), urea (ReU), and creatinine (ReCr) for 7.5% icodextrin versus glucose solutions (1.36%, 2.27%) across different dwell times and PSTRs.

Main Results:

• Replacing one of three or four daily glucose exchanges with a 7.5% icodextrin long dwell increased fluid and solute removal and UF efficiency.
• Substituting two glucose exchanges with one icodextrin exchange resulted in comparable or higher water removal and increased daily sodium removal.
• Slightly lower daily urea and creatinine removal was observed with icodextrin, regardless of patient PSTR.

Conclusions:

• A single 7.5% icodextrin exchange can effectively replace two glucose-based exchanges.
• Icodextrin demonstrated minimal differences in water and solute removal across PSTR groups, with stable UFE up to 16 hours.
• Icodextrin offers a viable alternative for enhanced fluid and solute management in PD, particularly for long dwell exchanges.