icodextrin and Renal-Insufficiency--Chronic

The impact of icodextrin (ico) on peritoneal dialysis (PD) extension and patient survival is well established. Predominantly, ico-based solutions were prescribed in high-transporter PD patients. Advantages of the ico-based solutions include increased biocompatibility, avoidance of glucotoxicity, enhanced ultrafiltration failure (UF), sodium removal rates, better metabolic and blood pressure control. Bimodal solutions and twice daily exchanges of ico-based solutions are two newly introduced strategies to avoid glucose exposure and/or enhance UF in PD patients with UF failure. In addition, a simplified schedule of PD using a single nocturnal exchange of ico in patients with refractory congestive heart failure may represent an alternative option to manage fluid removal and azotaemia. The use of a simplified schedule of PD with only two ico exchanges or a single ico exchange is a challenging approach for end-stage renal disease patients with preserved residual function who desire to initiate PD.

Topics: Dialysis Solutions; Glucans; Glucose; Heart Failure; Humans; Icodextrin; Peritoneal Dialysis; Renal Insufficiency, Chronic

Ultrafiltration failure is a significant cause of technique failure for peritoneal dialysis and subsequent transfer to hemodialysis.. Ultrafiltration failure is defined as failure to achieve at least 400 ml of net ultrafiltration during a 4 h dwell using 4.25% dextrose. Four major causes of ultrafiltration failure have been described. A highly effective peritoneal surface area is characterized by transition to a very rapid transport state with D/P creatinine >0.81. Low osmotic conductance to glucose is characterized by attenuation of sodium sieving and decreased peritoneal free water clearance to <26% of total ultrafiltration in the first hour of a dwell. Low effective peritoneal surface area manifests with decreases in the transport of both solute and water. A high total peritoneal fluid loss rate is the most difficult to diagnose clinically; failure to achieve ultrafiltration with an 8-10 h icodextrin dwell may provide a clue to diagnosis.. Knowledge of the specific pathophysiology of the various causes of ultrafiltration failure will aid in the diagnosis thereof.

Topics: Biological Transport; Body Water; Creatinine; Dialysis Solutions; Glucans; Glucose; Humans; Icodextrin; Peritoneal Dialysis; Renal Insufficiency, Chronic; Sodium; Survival Analysis; Time Factors; Treatment Failure; Ultrafiltration

Because of the absorption of glucose in peritoneal dialysis (PD) solution, PD patients show an atherogenic lipid profile, which is predictive of poor survival in PD patients. Lipoprotein subclasses consist of a continuous spectrum of particles of different sizes and densities (fraction). In this study, we investigated the lipoprotein fractions in PD patients with controlled serum low-density lipoprotein (LDL) cholesterol level, and evaluated the effects of icodextrin on lipid metabolism.. Forty-nine PD patients were enrolled in this cross-sectional study in Japan. The proportions of cholesterol levels to total cholesterol level (cholesterol proportion) in 20 lipoprotein fractions were measured using an improved method of high-performance gel permeation chromatography (HPGPC).. Twenty-six patients used icodextrin. Although no significant differences in cholesterol levels in LDL and high-density lipoprotein (HDL) were observed between the patients using icodextrin (icodextrin group) and control groups, HPGPC showed that the icodextrin group had significantly lower cholesterol proportions in the small LDL (t-test, p=0.053) and very small LDL (p=0.019), and significantly higher cholesterol proportions in the very large HDL and large HDL than the control group (p=0.037; p=0.066, respectively). Multivariate analysis adjusted for patient characteristics and statin use showed that icodextrin use was negatively associated with the cholesterol proportions in the small LDL (p=0.037) and very small LDL (p=0.026), and positively with those in the very large HDL (p=0.040), large HDL (p=0.047), and medium HDL (p=0.009).. HPGPC showed the relationship between icodextrin use and the cholesterol proportions in lipoprotein fractions in PD patients. These results suggest that icodextrin may improve atherogenic lipid profiles in a manner different from statin.

Topics: Chemical Fractionation; Cholesterol, LDL; Chromatography, Gel; Dialysis Solutions; Female; Glucans; Glucose; Humans; Icodextrin; Lipid Metabolism; Male; Middle Aged; Renal Insufficiency, Chronic; Treatment Outcome

The authors report the first case of successful peritoneal dialysis (PD) in a developing country performed about a 13-year-old adolescent followed-up for stage V chronic kidney disease (CKD) with anuria. After 3 months of hemodialysis, the parents opted for continuous ambulatory peritoneal dialysis (CAPD) as they wished to return home located 121km from Dakar. After PD catheter insertion, the plan proposed to the patient consisted 3-4 hours stasis of isotonic dialysate during the day and a night stasis of 8 hours of icodextrin for an injection volume of 1L per session. The patient and his mother were trained and assessed on the PD technique. After dialysis adequacy was tested while hospitalised, they were able to return home and continued the sessions following the same plan prescribed and while keeping in touch, by telephone, with the medical team. The technique assessment at the day hospital every 2 weeks revealed dialysis adequacy and satisfactory tolerance of PD at home after 04 months of observation. It was the first case of successful CAPD in the pediatrics unit in this context. Scaling this technique is a challenge for the pediatric nephrologist in developing countries like Senegal.

Topics: Adolescent; Developing Countries; Dialysis Solutions; Hemodialysis, Home; Humans; Icodextrin; Male; Peritoneal Dialysis, Continuous Ambulatory; Renal Dialysis; Renal Insufficiency, Chronic; Senegal

Psoriasis vulgaris is not frequently seen in patients with renal replacement therapy, especially in patients on peritoneal dialysis. Dialysis also has been reported to improve psoriatic skin lesions with a much higher response rate for peritoneal dialysis than haemodialysis. Conversely, we present a case of a man who developed psoriasis after 16 months of peritoneal dialysis. Discontinuation of icodextrin as a possible factor provoking systemic inflammation had no impact on the course of the disease. In this report, we review the existing studies and counsel caution against optimistic expectations of benefits from dialysis in patients with psoriasis.

Topics: Administration, Topical; Dialysis Solutions; Emollients; Glucans; Glucocorticoids; Glucose; Humans; Hypertension; Icodextrin; Male; Middle Aged; Peritoneal Dialysis; Psoriasis; Renal Insufficiency, Chronic; Treatment Outcome

Peritoneal dialysis (PD) is used as an alternative to hemodialysis in end-stage renal disease (ESRD). Icodextrin has been used as a hyperosmotic agent in PD. The aim of the study was to assess two different point-of-care testing (POCT) glucose strips, affected and not affected by icodextrin, with serum glucose concentrations of the patients using and not using icodextrin.. Fifty-two chronic ambulatory peritoneal dialysis (CAPD) patients using icodextrin (Extraneal®) and 20 CAPD patients using another hyperosmotic fluid (Dianeal®) were included in the study. Duplicate capillary and serum glucose concentrations were measured with two different POCT glucose strips and central laboratory hexokinase method. Assay principles of glucose strips were based on glucose dehydrogenase-pyrroloquinoline quinone (GDH-PQQ) and a mutant variant of GDH (Mut Q-GDH). The results of both strips were compared with those of hexokinase method.. Regression equations between POCT and hexokinase methods in icodextrin group were y = 2.55x + 1.12 mmol/l and y = 1.057x + 0.16 mmol/l for the GDH-PQQ and Mut Q-GDH methods, respectively. The mean difference between the results of hexokinase and those of GDH-PQQ and Mut Q-GDH in icodextrin group was 3.41 ± 1.56 and 0.72 ± 0.64 mmol/l, respectively. However, the mean differences were found much lower in the control group; 0.64 mmol/l for GDH-PQQ and 0.52 mmol/l for Mut Q-GDH.. Compared to GDH-PQQ, glucose strips of Mut Q-GDH correlated better with hexokinase method in PD patients using icodextrin.

Topics: Adult; Aged; Aged, 80 and over; Blood Glucose; Female; Glucans; Glucose; Glucose Dehydrogenases; Hematologic Tests; Hemodialysis Solutions; Hexokinase; Humans; Icodextrin; Male; Middle Aged; Peritoneal Dialysis; Renal Insufficiency, Chronic

Icodextrin is a solution of glucose polymers developed to provide sustained ultrafiltration over an extended dwell. Our aim was to determine whether or not fill volume with icodextrin contributes to the ability to achieve ultrafiltration in children.. The charts of all children on chronic peritoneal dialysis between January 2000 and July 2014 were screened for the use of an icodextrin day dwell. Data were extracted from the electronic chart and the HomeChoice™ Pro card and corrected for body surface area (BSA).. Fifty children had an icodextrin day dwell. A linear correlation was found between the daytime fill volume and net ultrafiltration (p < 0.001). More ultrafiltration was achieved with a fill volume above 550 ml/m(2) BSA (107 ± 75 ml/m(2) BSA) than with smaller fill volumes (-8 ± 99 ml; p = 0.004). Ultrafiltration was achieved in 88 % of children with a fill volume above 550 ml/m(2) BSA versus only 44 % of patients with a smaller fill volume (p = 0.001). Icodextrin was well tolerated.. Our observations reveal that the larger the fill volume the higher the likelihood of achieving ultrafiltration with icodextrin and suggest that a minimum day dwell volume of 550 ml/m(2) BSA seems to facilitate ultrafiltration in children. To our knowledge this is the largest study addressing ultrafiltration with icodextrin in children.

Topics: Adolescent; Body Surface Area; Child; Child, Preschool; Dialysis Solutions; Female; Glucans; Glucose; Humans; Icodextrin; Infant; Male; Peritoneal Dialysis; Renal Insufficiency, Chronic; Ultrafiltration

Peritoneal dialysis solution (PDS) plays a role in functional and morphological damage to the peritoneum. This study aimed to clarify the effect of neutral PDS in preventing morphological changes by assessing peritoneal damage and comparing morphological alterations between PD patients treated with neutral PDS and acidic PDS. Sixty-one patients participated from seven hospitals. All patients were treated with neutral PDS excluding icodextrin, during their entire PD treatment, and experienced no episode of peritonitis. The thickness of submesothelial compact (SMC) zone and the presence of vasculopathy in the anterior parietal abdominal peritoneum were assessed. The impact of icodextrin, hybrid therapy, and peritoneal rest and lavage in morphological alterations were determined. There was no significant difference in the average SMC thickness between neutral and acidic PDS. The vessel patency in patients using neutral PDS was significantly higher compared to that in acidic PDS at any time during PD. There were no significant suppressive effects from interventions or use of icodextrin with respect to peritoneal morphological injury. A monolayer of mesothelial cell was observed in approximately half the patients, especially in their receiving lavage patients. Neutral PDS, accompanied by other preventive approaches against peritoneal injury, might suppress the development of peritoneal morphological alterations.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Dialysis Solutions; Epithelial Cells; Female; Glucans; Glucose; Humans; Icodextrin; Male; Middle Aged; Peritoneal Dialysis; Peritoneum; Renal Insufficiency, Chronic; Young Adult

The results of a nationwide statistical survey of peritoneal dialysis (PD) in Japan (PD registry) were reported at the end of 2012. There were 9,514 PD patients at the end of 2012 (3.1%), indicating 128 fewer than in the 2011 survey (9,642 patients). There were 347 non-PD+catheter patients, and 175 patients were started on PD in 2012 but were switched to another therapy in the same year. The sum of these 522 patients and the total number of PD patients (i.e. the total number of PD-therapy-related patients) was 10,036 (522 + 9,514). The PD-only patients numbered 7,323 (80.4%), and the PD+hemodialysis (HD) patients numbered 1,788 (19.6%). Of these 9,111 PD patients, 1,428 patients (15.7%) underwent HD once per week; 219 patients (2.4%), twice per week; and 55 patients (0.6%), three times per week. The PD+HD patients (1,788) accounted for 19.6% of all PD patients. In addition, 39.8% of PD patients were using the poly-glucose dialysis solution icodextrin (Extraneal). Around 40% of PD patients were using icodextrin, a much higher percentage than in other countries. What is the likelihood that the number of PD patients in Japan will gradually decrease (or increase) in the future? Regarding the dialysis trend in Japan, it is unlikely that the number of PD patients will increase. I think that if the government greatly increases the medical insurance coverage of PD treatment, the number of PD patients in Japan will increase as much as it recently has in the United States. If not, it is extremely unlikely that there will be a large increase in the number of PD patients in Japan.

Topics: Dialysis Solutions; Glucans; Glucose; Humans; Icodextrin; Japan; Kidney Failure, Chronic; Peritoneal Dialysis; Renal Dialysis; Renal Insufficiency, Chronic

Refractory congestive heart failure (RCHF), due to its high mortality and hospitalization rates, is a growing health problem. In this study, as an alternative and/or supportive treatment to conventional medical therapies, we have evaluated the clinical value of peritoneal ultrafiltration, performed as a single daily exchange with icodextrin or conventional dextrose-based peritoneal dialysis solutions, in elderly patients with RCHF.. This was an observational study of 6 elderly patients with RCHF and non-terminal chronic kidney disease (CKD). Their mean age was 72.8 ± 4.9 years. Four of the six patients had NYHA class 4 and two had NYHA class 3 RCHF and a medical history of 18.6 ± 14.9 days/year hospitalization on average, due to decompensated congestive heart failure (CHF). Their baseline glomerular filtration rate, as calculated by the MDRD formula was 49.4 ± 14.6 mL/min/1.73 m(2). During hospitalization, patients were initially treated with several sessions of continuous veno-venous hemofiltration and, following the achievement of hemodynamic stabilization, peritoneal ultrafiltration was initiated as the maintenance ultrafiltration modality. Patients were followed up monthly in terms of their clinical status, hospitalization rates, weight changes, serum sodium levels, and renal function. Echocardiographic changes were also evaluated every 3 months.. All patients tolerated peritoneal ultrafiltration well, their functional status improved by 1 or 2 NYHA classes to reach a mean of NYHA class 2 CHF status. During the follow-up period, with a mean daily ultrafiltration rate of 850 ± 176 mL, no hospitalization for decompensated CHF or acute renal failure was required. The patients' renal function was well preserved, with a mean GFR of 49 ± 14.6 mL/min/1.73 m(2) at baseline and 51.6 ± 22.9 mL/min/1.73 m(2) at the 6th month of the study. Additionally, their mean serum sodium levels increased from 128 ± 5.7 mEq/L to 138 ± 5 mEq/L. Echocardiographic evaluation did not show any significant changes during the observation period. No peritonitis or other non-infectious complication of chronic peritoneal dialysis was seen in any of the patients.. Peritoneal ultrafiltration seems to be an efficient and safe procedure and a treatment of choice in elderly patients with RCHF without non-terminal CKD. Peritoneal ultrafiltration improves the quality of life and the effort capacity, and reduces hospitalization rates due to decompensated heart failure and acute renal failure.

Topics: Aged; Dialysis Solutions; Echocardiography; Female; Glomerular Filtration Rate; Glucans; Glucose; Heart Failure; Hospitalization; Humans; Icodextrin; Male; Peritoneal Dialysis; Renal Insufficiency, Chronic; Retrospective Studies; Sodium; Ultrafiltration

Over a period of 6.5 years, we treated 19 patients, all of whom suffered from severe heart failure and various stages of chronic kidney disease, excluding those with end-stage kidney failure. Before peritoneal catheter implantation, all patients had ascites, dyspnea, orthopnea, and an ejection fraction ranging from 20 to 45%. Seven of them (7/19) were able to take care of themselves, 9/19 needed assistance for their daily activities, and the remaining 3 were bedridden. All of them needed hospitalization 1 - 3 times/month during the year before the initiation of continuous ambulatory peritoneal dialysis (CAPD). With peritoneal dialysis, daily ultrafiltrate volume ranged from 500 to 3,000 ml and, after an average of 2 months of peritoneal dialysis, body weight decreased significantly (74.7 ± 13 vs. 69.7 ± 10.2, p = 0.02). At the same time, diuresis improved significantly, and this allowed a reduction in the dose of diuretics. Dyspnea and orthopnea improved significantly in all patients. The patients' degree of self-care and ability to sleep lying flat improved significantly as the need for hospitalization declined. Before peritoneal dialysis, patients were hospitalized for 5 - 20 days/month for pulmonary edema or overhydration, whereas with peritoneal dialysis, nobody was hospitalized for these causes (chi2, p = 0.0001). Ejection fraction also improved in all of them (28.6 ± 8.6 vs. 36.8 ± 12.5%, p = 0.0001). Actual survival of our patients ranged from 6 to 86 months (mean ± SD = 24.6 ± 20.8). Actuarial survival was 68% at 1 year and 42% at 2 years. During peritoneal dialysis we observed only two episodes of peritonitis. Four patients developed a severe episode of hypotension during implantation of the catheters from the sudden removal of 4 - 6 l of ascitic fluid. We conclude that peritoneal dialysis is a good method for the treatment of congestive heart failure because it increases the quality of life and life expectancy in patients with poor prognosis.

Topics: Actuarial Analysis; Aged; Aged, 80 and over; Glucans; Glucose; Heart Failure; Hemodialysis Solutions; Humans; Icodextrin; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Renal Insufficiency, Chronic; Stroke Volume; Survival Analysis; Treatment Outcome

A 67-year-old woman was admitted to our hospital because of anasarca due to refractory nephrotic syndrome and chronic renal insufficiency. Laboratory data indicated serum total protein of 4.8 g/dl, albumin of 1.5 g/dl, creatinine of 1.9 mg/dl and BUN of 17 mg/dl. Urinary protein excretion was 7.8 g/day. Because of severe atrophy of both kidneys, neither renal biopsy nor immunosuppressive treatment was performed. Since conservative management including bed rest, diet therapy, limitation of water intake and administration of diuretics was not effective, peritoneal dialysis therapy using icodextrin only at night was started. The amount of water removal was steadily secured without progressing renal dysfunction or decreasing urine volume. From day 290 onward, the urinary protein excretion was decreased to show complete remission and urine volume increased. On day 528, peritoneal dialysis was discontinued, and thereafter only peritoneal lavage was performed. On day 858, the catheter was removed from the abdominal cavity, and thereafter diuretics could be discontinued. The reason for the dramatic reduction of urinary protein in this patient is unclear. However, it is possible that the primary disease such as membranous nephritis showed remission while the patient was undergoing icodextrin peritoneal dialysis, which preserves renal function but not extracorporeal ultrafiltration or hemodialysis. Icodextrin peritoneal dialysis may be an alternative to hemodialysis for refractory fluid overload in patients with nephrotic syndrome and may have the advantage of preserving renal function.

Topics: Aged; Atrophy; Diuretics; Drug Administration Schedule; Female; Glucans; Glucose; Hemodialysis Solutions; Humans; Icodextrin; Kidney; Nephrotic Syndrome; Peritoneal Dialysis; Peritoneal Lavage; Proteinuria; Renal Insufficiency, Chronic; Time Factors; Treatment Outcome