icodextrin and Diabetes-Mellitus--Type-2

Patients on chronic ambulant peritoneal dialysis (CAPD) are increasingly likely to be treated with a new solution of corn starch-derived glucose polymers called icodextrin. This solution involves a very low carbohydrate absorption leading to a better glycemic control in diabetic patients. However these glucose polymers pass to the blood and are metabolized to oligosaccharids which interfere with blood glucose in distinct capillary glucose analyzers leading to overestimation of glycemia. We assessed the accuracy of glucose measurements with the three most commonly used glucose analyzers compared to venous plasma glucose measurement at our institution in 8 patients (4 patients with type 2 diabetes) on CAPD using icodextrin. Glycemia was measured simultaneously in plasma of venous blood using a reference laboratory method and in capillary blood using Accu-Chek sensor (Rotkreuz, Switzerland) (glucose dehydrogenase method), Glucotrend 2 (Rotkreuz, Switzerland) (glucose-dye-oxyreductase method) and Ascensia elite (Zurich, Switzerland) (glucose oxidase method) glucose analyzers. Only glucose readings with Ascensia elite correspond correctly with venous plasma glucose results (+0.3 mmol/l; n. s.), whereas glycemia was significantly overestimated by Accu-Chek sensor (+4.3 mmol/l; p<0.0001) and Glucotrend 2 glucose analyzers (+3.7 mmol/l; p<0.0001). Thus we conclude that distinct glucose analyzers overestimate real blood glucose concentration and are not suitable for monitoring glycemia in patients on CAPD with icodextrin. On the basis of our results, these patients should use glucose analyzers using glucose oxidase methods. All glucose analyzers should be cross-checked with a laboratory reference method before the application in patients on CAPD with icodextrin is recommended.

Topics: Blood Glucose; Blood Glucose Self-Monitoring; Diabetes Mellitus, Type 2; Glucans; Glucose; Humans; Icodextrin; Peritoneal Dialysis, Continuous Ambulatory

Little is known about the haemodynamic effects of continuous ambulatory peritoneal dialysis (CAPD) despite its widespread use in the management of end-stage renal failure. We undertook a study to delineate the haemodynamic effects of CAPD using glucose-containing fluids (1.36 and 3.86% glucose) and icodextrin.. Eight CAPD patients were recruited for a prospective crossover study. Patients attended for two investigatory days (in random order). CAPD was carried out using 1.36% followed by 3.86% glucose (buffered with lactate/bicarbonate, Physioneal) on one study day and 1.36% glucose followed by 7.5% icodextrin (Extraneal) on the other day. Dwell times were 150 min. Blood pressure (BP) and a full range of haemodynamic variables including pulse (HR), stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were measured non-invasively using continuous arterial pulse wave analysis.. BP was significantly higher during 3.86% glucose dwells as compared with 1.36% glucose or icodextrin dwells (P<0.0001). TPR during all three dwells was similar; the higher blood pressure was due to an increased HR, SV and, therefore, CO during 3.86% glucose dwells. The higher blood pressure during the 3.86% glucose dwells was present despite the highest ultrafiltration volume and sodium removal.. This study demonstrates large magnitude haemodynamic changes in response to CAPD. In addition to the well-recognized adverse effects on blood glucose and long-term peritoneal membrane viability, CAPD fluids containing high glucose concentrations may also exert undesirable effects on systemic haemodynamics, with potential long-term consequences for patient outcomes.

Topics: Aged; Aged, 80 and over; Cross-Over Studies; Diabetes Mellitus, Type 2; Female; Glucans; Glucose; Hemodialysis Solutions; Hemodynamics; Humans; Hypertension; Icodextrin; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory

Metabolic syndrome (MetS) is commonly observed among peritoneal dialysis (PD) patients, and hyperbranched polyglycerol (HPG) is a promising glucose-sparing osmotic agent for PD. However, the biocompatibility of a HPG-based PD solution (HPG) in subjects with MetS has not been investigated. This study compared the local and systemic effects of a HPG solution with conventional physioneal (PYS) and icodextrin (ICO) PD solutions in rats with MetS. Obese type 2 diabetic ZSF1 rats received a daily intraperitoneal injection of PD solutions (10 mL) for 3 months. The peritoneal membrane (PM) function was determined by ultrafiltration (UF), and the systemic responses were determined by profiling blood metabolic substances, cytokines and oxidative status. Tissue damage was assessed by histology. At the end of the 3-month treatment with PD solutions, PM damage and UF loss in both the PYS and ICO groups were greater than those in the HPG group. Blood analyses showed that compared to the baseline control, the rats in the HPG group exhibited a significant decrease only in serum albumin and IL-6 and a minor glomerular injury, whereas in both the PYS and ICO groups, there were more significant decreases in serum albumin, antioxidant activity, IL-6, KC/GRO (CXCL1) and TNF-α (in ICO only) as well as a more substantial glomerular injury compared to the HPG group. Furthermore, PYS increased serum creatinine, serum glucose and urine production. In conclusion, compared to PYS or ICO solutions, the HPG solution had less adverse effects locally on the PM and systemically on distant organs (e.g. kidneys) and the plasma oxidative status in rats with MetS.

Topics: Animals; Biomarkers; Cytokines; Diabetes Mellitus, Type 2; Dialysis Solutions; Disease Models, Animal; Glycerol; Icodextrin; Inflammation Mediators; Injections, Intraperitoneal; Kidney; Male; Obesity; Organic Chemicals; Oxidative Stress; Peritoneal Dialysis; Peritoneum; Permeability; Polymers; Rats, Zucker; Time Factors

Diabetes mellitus (DM) is the most common cause of end-stage renal disease and is an important risk factor for morbidity and mortality after dialysis. However, glycemic control among such patients is difficult to assess. The present study examined glycemic control parameters and observed glucose variation after refilling different kinds of fresh dialysate in peritoneal dialysis (PD) patients.. A total of 25 DM PD patients were recruited, and continuous glucose monitoring system (CGMS) was applied to measure interstitial fluid (ISF) glucose levels at 5-min intervals for 3 days. Patients filled out diet and PD fluid exchange diaries. The records measured with CGMS were analyzed and correlated with other glycemic control parameters such as fructosamine, albumin-corrected fructosamine (AlbF), glycosylated hemoglobin (HbA1c), and glycated albumin levels.. There were significant correlations between mean ISF glucose and fructosamine (r = 0.45, P<0.05), AlbF (r = 0.54, P<0.01), and HbA1c (r = 0.51, P<0.01). The ISF glucose levels in glucose-containing dialysate increased from approximately 7-8 mg/dL within 1 hour of exchange in contrast to icodextrin dialysate which kept ISF glucose levels unchanged.. HbA1c and AlbF significantly correlated with the mean ISF glucose levels, indicating that they are reliable indices of glycemic control in DM PD patients. Icodextrin dialysate seems to have a favorable glycemic control effect when compared to the other glucose-containing dialysates.

Topics: Aged; Blood Glucose; Diabetes Mellitus, Type 2; Dialysis Solutions; Extracellular Fluid; Female; Fructosamine; Glucans; Glucose; Glycated Hemoglobin; Glycated Serum Albumin; Glycation End Products, Advanced; Humans; Icodextrin; Kidney Failure, Chronic; Male; Middle Aged; Monitoring, Physiologic; Peritoneal Dialysis, Continuous Ambulatory; Serum Albumin

Icodextrin, a peritoneal dialysate commonly used in the renal failure patient with diabetes, may lead to an overestimation of blood glucose levels as determined by bedside glucometers. This spurious hyperglycemia can lead to significant morbidity if unrecognized. We describe a case of severe hypoglycemia caused by an unappreciated overestimation of blood glucose in a diabetic patient with concomitant chronic renal failure requiring peritoneal dialysis with icodextrin.

Topics: Diabetes Mellitus, Type 2; Female; Glucans; Glucose; Humans; Hypoglycemia; Icodextrin; Middle Aged; Peritoneal Dialysis

Recent reports have indicated that icodextrin may interfere with glucose assays when patients are treated with icodextrin for peritoneal dialysis (PD). We wished to examine whether icodextrin interfered with plasma glucose, as measured with new instruments commonly used for glucose measurements in Norway.. Serum and plasma glucose were measured in a diabetic patient (type II) who had started PD with icodextrin. Serum glucose was measured simultaneously in venous blood using the laboratory reference method (hexokinase), and compared with eight point of care testing (POCT) glucometers. The instruments used glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ), glucose dehydrogenase nicotinamide adenine dinucleotide (GDH- NAD), or glucose oxidase (GOx) methods.. The laboratory reference method for glucose measurements was not affected by icodextrin. Biosensors with GDH-NAD and GOx methods did not give falsely elevated glucose results. Two of the eight POCT glucometers used the GDH-PQQ method. Both Ascensia Contour (Bayer HealthCare) and Accu-Chek (Roche Diagnostics) showed more than 60 % higher glucose values than the reference method.. The GDH-PQQ method is non-specific for measurements of glucose. Over-estimation of glucose may result in unrecognized hypoglycaemia. POCT glucometers with a GDH-PQQ based monitoring system should not be used in diabetics receiving icodextrin for PD. The patients and caregivers must be informed about which glucometers to use.

Topics: Aged; Autoanalysis; Blood Glucose; Diabetes Mellitus, Type 2; Dialysis Solutions; False Positive Reactions; Glucans; Glucose; Humans; Icodextrin; Kidney Failure, Chronic; Male; Peritoneal Dialysis, Continuous Ambulatory; Point-of-Care Systems; Reference Standards

In a patient with diabetes mellitus undergoing icodextrin continuous ambulatory peritoneal dialysis, the interference caused by icodextrin metabolites in bedside glucose analyzers led to an overestimation of capillary glucose levels and the potential for inappropriate therapy. We report this case to raise an awareness of this among emergency care providers who are at the front-line treating diabetes emergencies.

Topics: Aged; Blood Glucose; Diabetes Mellitus, Type 2; Glucans; Glucose; Humans; Hypoglycemia; Icodextrin; Insulin; Kidney Failure, Chronic; Male; Peritoneal Dialysis

Topics: Aged; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Glucans; Glucose; Hemodialysis Solutions; Humans; Hyperglycemia; Icodextrin; Male; Peritoneal Dialysis