icodextrin and Cardiomegaly

Among end-stage renal disease (ESRD) patients, cardiovascular disease is a common comorbidity and one of most important factors affecting clinical prognosis. Calcium deposition has been reported to correlate with plasma phosphate. Icodextrin (Ico)-based peritoneal dialysis (PD) has many advantages over glucose (Glu)-based PD. We aimed to identify factors that suppress arteriosclerosis and valvular disease in patients with ESRD and diabetes mellitus (DM) undergoing Ico-based PD. In this retrospective study, we evaluated the effects of Ico-based PD (n = 20) on phosphate elimination and cardiovascular disease progression in patients with ESRD andDM, and we compared the results with those for Glu-based PD (n = 20). Left ventricular mass index (LVMI) and aortic valve calcification (AVC) score were significantly decreased and daily phosphate elimination was significantly increased in the Ico group compared with the Glu group. Furthermore, mean daily phosphate elimination was significantly and negatively correlated with the amelioration in LVMI and AVC score. Our study suggests that, compared with glucose, icodextrin has the ability to eliminate more phosphate from the body, indicating that phosphate elimination might potentially be a means of controlling cardiovascular disease in PD patients with DM.

Topics: Adult; Aged; Calcinosis; Cardiomegaly; Coronary Artery Disease; Diabetic Nephropathies; Disease Progression; Female; Glucans; Glucose; Heart Valve Diseases; Heart Valves; Hemodialysis Solutions; Humans; Hyperphosphatemia; Icodextrin; Kidney Failure, Chronic; Male; Middle Aged; Phosphates; Retrospective Studies

Better control of cardiovascular function in patients on peritoneal dialysis (PD) is critical because PD patients have a tendency to overhydration, which has been proved to be associated with cardiovascular and patient outcome. In the general population, lipid metabolism is also considered to be an important indicator of future cardiovascular events. Icodextrin has been used to improve ultrafiltration volume without increasing dextrose load. We therefore expected that parameters of lipid metabolism and cardiovascular function could both be improved, or at least maintained, after icodextrin use in PD patients. We therefore analyzed those parameters in 14 prevalent PD patients who required a switch from dextrose to icodextrin solution for the long dwell at 1 year before the switch, at the time of the switch, and at 1 and 2 years after the switch. In the study patients, cardiovascular remodeling evaluated by ultrasonographic left ventricular mass index was diminished, but the intima media area of the cervical artery was elevated after icodextrin use. Intima media thickness did not change over time. Biochemical indices such as brain natriuretic peptide, atrial natriuretic peptide, lipoprotein A, total cholesterol, and triglycerides were all lower after icodextrin use. These results indicate that icodextrin has the potential to improve lipid metabolism, volemic status, and cardiac hypertrophy in prevalent PD patients. However, atherosclerotic vascular change is refractory to improvement.

Topics: Arteries; Atrial Natriuretic Factor; Cardiomegaly; Dialysis Solutions; Glucans; Glucose; Hemodialysis Solutions; Humans; Icodextrin; Lipid Metabolism; Middle Aged; Natriuretic Peptide, Brain; Neck; Peritoneal Dialysis; Tunica Intima; Tunica Media; Ultrasonography; Ventricular Remodeling; Water-Electrolyte Balance