An exploratory assessment of icodextrin for ultrafiltration failure subtypes in peritoneal dialysis

Although icodextrin was initially developed for rapid transporters (type 1 UFF), emerging evidence suggests its effects might be independent of peritoneal membrane transport characteristics. This study aimed to evaluate the suitability of 7.5% icodextrin for all PD patients with UFF. We enrolled 19 patients with UFF and 24 non-UFF PD controls. All participants underwent standard, modified, Mini-, and Double-Mini peritoneal equilibrium tests (PET). Key parameters assessed included sodium sieving (∆DNa60, ∆D/PNa60), osmotic conductance to glucose, small-pore ultrafiltration (UFSP), free water transport (FWT), and net ultrafiltration. Correlation analyses were conducted between icodextrin-induced UF and these metrics. Descriptive analysis revealed variations in icodextrin UF, ∆D/PNa60, and FWT were identified across the four UFF types. Numerically, icodextrin UF was highest in type 1 and type 2 UFF, while FWT appeared lower in type 2. Net icodextrin UF correlated positively with ∆D/PNa60, ∆DNa60, and UFSP. Our findings indicate that 7.5% icodextrin may be suitable for PD patients with type 1 and 2 UFF, but appears perhaps less effective in those with type 3 and 4 UFF.Moreover, icodextrin ultrafiltration may be predictable through UFSP measurement, offering a potential clinical tool for patient management.