icodextrin and Dyslipidemias

Treatment of end-stage renal disease with peritoneal dialysis is associated with an obligatory absorption of carbohydrates with both glucose and icodextrin-based dialysate. In this review, we examine the evidence linking this obligatory absorption with adverse systemic effects.. Systemic glucose absorption is associated with worse glycemic control; this can be ameliorated with glucose-sparing peritoneal dialysis regimens. The studies examining the benefit of glucose-sparing regimens on dyslipidemia are inconsistent and the magnitude of benefit is potentially small. There are no studies demonstrating any improvement in clinically meaningful patient outcomes with glucose-sparing regimens.. Although it is conceivable that the obligatory carbohydrate absorption with peritoneal dialysis increases systemic cardiovascular risk, this premise has not been systematically or rigorously examined to date, there are no robust biomarkers to measure the risk, modification of which may favorably improve outcomes, and whether glucose-sparing peritoneal dialysis regimens will lower the putative risk is currently unknown. Hence, there is a compelling need to bridge our gap in understanding the role of systemic glucose absorption with peritoneal dialysis on the health of individuals undergoing peritoneal dialysis.

Topics: Absorption; Blood Glucose; Dialysis Solutions; Dyslipidemias; Glucans; Glucose; Humans; Icodextrin; Kidney Failure, Chronic; Peritoneal Dialysis; Risk Factors; Weight Gain

The Stoke Renal Unit has been at the forefront of peritoneal dialysis (PD) research for much of the past two decades. Central to this work is the PD cohort study, which was started in 1990 and is based on regular outpatient measurements of peritoneal and clinical function, correlating these with long-term outcomes. It has provided a wealth of information on risk factors for morbidity and mortality in patients on PD, the most significant being demonstration of the effects of time and dialysate glucose exposure on changes to the peritoneal membrane, as evidenced by increases in small solute transport. Early on, the study confirmed the adverse relationship between high small-solute transport status and outcome but more recently suggested that this relationship no longer held with modern techniques for managing patients on PD. Central themes of the PD research in Stoke have included evaluation of euvolemia, the importance of ultrafiltration and how best to achieve it, and detailed assessments of transmembrane water movement. The work has included the study of sodium removal and the use of novel low sodium dialysates. More recently, attention has turned to the significance of impaired ultrafiltration capacity in patients on PD as a sign of structural membrane damage. It is hoped that further work in this area will identify preventive strategies.

Topics: Biological Transport; Body Water; Cohort Studies; Comorbidity; Dialysis Solutions; Dyslipidemias; England; Extracellular Fluid; Glucans; Glucose; Humans; Icodextrin; Nutritional Physiological Phenomena; Peritoneal Dialysis; Peritoneum; Research; Risk Factors; Sodium; Treatment Outcome; Ultrafiltration

Among the different cardiovascular risk factors, lipid abnormalities dominate the high mortality in chronic ambulatory peritoneal dialysis patients. So far, no data comparing the effect of standard glucose-containing, amino acid-containing, and icodextrin-containing peritoneal dialysis solutions on serum lipid concentrations in a chronic ambulatory peritoneal dialysis population are available. To determine the effect of peritoneal dialysis solutions on parameters of lipid metabolism, 67 subjects who had continued their usual dialysis for the last six months were enrolled in the study. Group A consisted of 18 patients who were receiving only glucose-based peritoneal dialysis solutions, group B consisted of 18 patients who were receiving glucose and amino acid-based peritoneal dialysis solutions, and group C consisted of 31 patients who were receiving glucose and icodextrin-based peritoneal dialysis solutions. Serum lipid parameters including total cholesterol, low-density lipoprotein, high-density lipoprotein, triglyceride, and lipoprotein (a) were determined in all groups. No significant difference in serum lipid parameters was found between groups A, B, and C. These results demonstrate the lack of the effect of amino acid or icodextrin-based peritoneal solutions on dyslipidemia of CAPD patients.

Topics: Adult; Aged; Aged, 80 and over; Amino Acids; Biomarkers; Cholesterol, HDL; Cholesterol, LDL; Cross-Sectional Studies; Dialysis Solutions; Dyslipidemias; Female; Glucans; Glucose; Humans; Icodextrin; Kidney Failure, Chronic; Lipids; Lipoprotein(a); Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Treatment Outcome; Triglycerides