Impact of icodextrin on clinical outcomes in peritoneal dialysis: a systematic review of randomized controlled trials

Cho, Yeoungjee, Johnson, David W., Badve, Sunil, Craig, Jonathan C., Strippoli, Giovanni F. K. and Wiggins, Kathryn J. (2013) Impact of icodextrin on clinical outcomes in peritoneal dialysis: a systematic review of randomized controlled trials. Nephrology Dialysis Transplantation, 28 7: 1899-1907. doi:10.1093/ndt/gft050


Author Cho, Yeoungjee
Johnson, David W.
Badve, Sunil
Craig, Jonathan C.
Strippoli, Giovanni F. K.
Wiggins, Kathryn J.
Title Impact of icodextrin on clinical outcomes in peritoneal dialysis: a systematic review of randomized controlled trials
Journal name Nephrology Dialysis Transplantation   Check publisher's open access policy
ISSN 0931-0509
1460-2385
Publication date 2013-07
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1093/ndt/gft050
Volume 28
Issue 7
Start page 1899
End page 1907
Total pages 9
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2014
Language eng
Formatted abstract
Background Although icodextrin has been shown to augment peritoneal ultrafiltration in peritoneal dialysis (PD) patients, its impact upon other clinical end points, such as technique survival, remains uncertain. This systematic review evaluated the effect of icodextrin use on patient level clinical outcomes.

Methods The Cochrane CENTRAL Registry, MEDLINE, Embase and reference lists were searched (last search 13 September 2012) for randomized controlled trials of icodextrin versus glucose in the long dwell exchange. Summary estimates of effect were obtained using a random effects model.

Results Eleven eligible trials (1222 patients) were identified. There was a significant reduction in episodes of uncontrolled fluid overload [two trials; 100 patients; relative risk (RR) 0.30, 95% confidence interval (CI) 0.15–0.59] and improvement in peritoneal ultrafiltration [four trials; 102 patients; mean difference (MD) 448.54 mL/day, 95% CI 289.28–607.80] without compromising residual renal function [four trials; 114 patients; standardized MD (SMD) 0.12, 95% CI −0.26 to 0.49] or urine output (three trials; 69 patients; MD −88.88, 95% CI −356.88 to 179.12) with icodextrin use for up to 2 years. There was no significant effect on peritonitis incidence (five trials; 607 patients; RR 0.97, 95% CI 0.76–1.23), peritoneal creatinine clearance (three trials; 237 patients; SMD 0.36, 95% CI −0.24 to 0.96), technique failure (three trials; 290 patients; RR 0.58, 95% CI 0.28–1.20), patient survival (six trials; 816 patients; RR 0.82, 95% CI 0.32–2.13) or adverse events.

Conclusions Icodextrin prescription improved peritoneal ultrafiltration, mitigated uncontrolled fluid overload and was not associated with increased risk of adverse events. No effects of icodextrin on technique or patient survival were observed, although trial sample sizes and follow-up durations were limited.
Keyword Icodextrin
Outcomes
Peritoneal dialysis
Ultrafiltration
Glucose solutions
Fluid management
Daytime dwell
Ultrafiltration
Biocompatibility
Safety
Parameters
Efficacy
Improves
Volume
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
School of Medicine Publications
 
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