The Double-Icodextrin Dose Randomized Controlled Trial of a Double Icodextrin Dose for Older Patients on Incremental...

Area of Science:

• Nephrology
• Dialysis Technology
• Clinical Trials

Background:

• Icodextrin enhances ultrafiltration (UF) in peritoneal dialysis (PD) patients.
• Current guidelines restrict icodextrin use to one bag per day.

Purpose of the Study:

• To investigate the superiority and safety of using two bags of icodextrin daily versus one bag.
• To determine if a double dose of icodextrin can extend the duration of incremental continuous ambulatory PD (CAPD) in older patients.

Main Methods:

• A prospective randomized trial (Double-Icodextrin Dose [DIDo] study) was conducted.
• Patients were randomized to either a double dose (2 icodextrin bags + 1 glucose bag) or a single dose (1 icodextrin bag + 2 glucose bags) daily.
• The primary endpoint was a composite of excessive hypertonic dialysate use, transfer to another dialysis modality, or death at 9 months.

Main Results:

• Forty-one patients received the double dose and 42 received the single dose.
• The proportion of patients discontinuing 3 exchanges/day was similar between groups at 9 and 18 months.
• Patients receiving double-dose icodextrin had higher net UF and used less hypertonic dialysate.

Conclusions:

• In older patients on incremental CAPD, a double icodextrin dose did not reduce the primary outcome incidence compared to a single dose.
• Double-dose icodextrin significantly enhanced UF and was found to be safe, with no identified safety issues.