icodextrin and Acidosis

20-70% of peritoneal dialysis patients have some signs of malnutrition. Anorexia, protein and amino acid losses in dialysate, advanced age of elderly patients, inflammation and cardiac failure are among the main causes. Modern dialysis solutions aim to reduce these causes, but none of them is without side effects: glucose is relatively safe and brings additional energy but induces anorexia and lipid abnormalities, amino acids compensate dialysate losses but may increase uremia and acidosis, icodextrin helps control hyperhydration and chronic heart failure and minimizes glucose side effects, but may sometimes cause inflammation, and poly chamber bags allow the replacement of lactate by bicarbonate and are more biocompatible, decrease GDP, induce less inflammation and have a better effect on nutritional status. However, it appears that the management of nutrition with the different solutions available nowadays necessitates various combinations of solutions adapted to different patient profiles and there is not actually a single universal solution to minimize malnutrition in peritoneal dialysis patients.

Topics: Acidosis; Adult; Age Factors; Aged; Female; Glucans; Glucose; Hemodialysis Solutions; Humans; Icodextrin; Inflammation; Male; Malnutrition; Middle Aged; Peritoneal Dialysis

This paper reviews the most recent clinical data on the volume status of long-term peritoneal dialysis (PD) patients. It appears that many PD patients are volume overloaded, associated with a high prevalence of hypertension and left ventricular hypertrophy. In the presence of the poor results in patients with peritoneal ultrafiltration, the introduction of the polyglucose solution, icodextrin, has ameliorated volume control in some of these patients. In a second part of the review, some of the structural and functional alterations in the peritoneal membrane and the role of glucose degradation products (GDP) in the commonly used dialysates as well as the resulting formation of advanced glycation end products are described. The introduction of low GDP-containing solutions at normal pH has at least in experimental models of PD attenuated the hemodynamic changes observed with the classical solutions. The solutions at normal pH containing either bicarbonate or a mixture of bicarbonate/lactate were clinically associated with less inflow pain.

Topics: Acidosis; Bicarbonates; Blood Volume; Double-Blind Method; Glucans; Glucose; Glycation End Products, Advanced; Hemodialysis Solutions; Humans; Hypertension; Hypertrophy, Left Ventricular; Icodextrin; Kidney Failure, Chronic; Lactates; Multicenter Studies as Topic; Pain; Peritoneal Dialysis; Peritonitis; Randomized Controlled Trials as Topic; Sodium; Treatment Failure