Abstract
A Randomized, Controlled Trial Comparing Icodextrin with Glucose in Chinese Prevalent Peritoneal Dialysis Patients: Impact on Ultrafiltration and Lipid Profile
Objective: Peritoneal dialysis (PD) with icodextrin (ICO) is commonly used in Caucasian patients with poor peritoneal membrane characteristics, but data on the usefulness of this solution in Chinese patients, who commonly exhibit a more beneficial peritoneal transport profile, are limited.
Methods: We randomized stable, prevalent, continuous ambulatory PD patients to either 7.5% ICO or glucose (GLU) solution for 4 weeks. Peritoneal membrane function [dialysate-to-plasma creatinine (D/PCr), creatinine clearance (CCr), urea nitrogen clearance (CBUN), and ultrafiltration (UF) during the long night dwell] and metabolic biomarkers were measured at baseline and at 2 and 4 weeks.
Results: The study enrolled 201 patients [96 men, 105 women; mean age: 56.1 ± 13.7 years (range: 18 – 81 years)]. Eighteen patients (9%) dropped out. There were no significant differences in adverse event rates and no baseline differences between the two groups. After 2 and 4 weeks of therapy, CCr, CBUN, and UF were all significantly higher in the ICO group than in the GLU group. Additionally, switching to ICO resulted in a significant increase in UF as compared with baseline in high (H), high-average (HA), and low-average (LA) transporters. The association between UF and D/PCr was positive (r2 = 0.17, p < 0.0001) in the ICO group, but negative in the GLU group (r2 = 0.10, p < 0.01). Blood cholesterol level in the ICO group as compared with the GLU group declined significantly (5.03 ± 1.83 mmol/L vs. 4.69 ± 1.12 mmol/L, p < 0.05).
Conclusions: Compared with GLU solution, 7.5% ICO solution can significantly improve UF and small-solute clearances, even in patients with low-average peritoneal transport. ICO may also improve lipid profile.