Predictors of a favourable response to icodextrin in peritoneal dialysis patients with ultrafiltration failure

Wiggins, Kathryn J., Rumpsfeld, Markus, Blizzard, Sophie and Johnson, David W. (2005) Predictors of a favourable response to icodextrin in peritoneal dialysis patients with ultrafiltration failure. Nephrology, 10 1: 33-36. doi:10.1111/j.1440-1797.2005.00361.x


Author Wiggins, Kathryn J.
Rumpsfeld, Markus
Blizzard, Sophie
Johnson, David W.
Title Predictors of a favourable response to icodextrin in peritoneal dialysis patients with ultrafiltration failure
Journal name Nephrology   Check publisher's open access policy
ISSN 1320-5358
Publication date 2005-02-01
Sub-type Article (original research)
DOI 10.1111/j.1440-1797.2005.00361.x
Volume 10
Issue 1
Start page 33
End page 36
Total pages 4
Editor D. C. H. Harris
Place of publication Carlton, Vic.
Publisher Blackwell Science
Collection year 2005
Language eng
Subject C1
730118 Organs, diseases and abnormal conditions not elsewhere classified
110312 Nephrology and Urology
Formatted abstract
Background and Aims: Icodextrin is a starch-derived glucose polymer that causes sustained ultrafiltration in long dwells in peritoneal dialysis. The aim of this study was to assess factors that were predictive of an increment in ultrafiltration following the introduction of icodextrin in patients with refractory fluid overload.

Methods: Thirty-nine patients (20 male/19 female, mean age 57.7 +/- 2.4 years) on peritoneal dialysis were enrolled in a prospective pretest/post-test, open-label study. All patients had symptomatic fluid overload refractory to fluid restriction (< 800 mL/ day), frusemide doses of 250 mg or more daily, optimization of dwell time and use of hypertonic dextrose. An icodextrin exchange was substituted for a 4.25% dextrose exchange for the long-dwell period.

Results: After 1 month, median (interquartile range) 24 h ultrafiltration volume increased by 500 mL (interquartile range: 50 - 1000). An increase in ultrafiltration volume correlated positively with the dialyate : plasma creatinine ratio at 4 h (r = 0.498, P = 0.001) and negatively with the ratio of dialysate glucose concentrations at 4 and 0 h (r = - 0.464, P = 0.003). On multivariate regression analysis, high transporter status was predictive of a greater ultrafiltration response to icodextrin relative to dextrose peritoneal dialysis exchanges. Age, sex, race, peritoneal dialysis duration, peritoneal dialysis modality, diabetes mellitus, baseline albumin, and baseline ultrafiltration volume were not significantly correlated with the change in ultrafiltration volume.

Conclusion: Icodextrin significantly augments ultrafiltration volumes in patients with refractory fluid overload. A high peritoneal membrane transporter status is the best predictor of a favourable ultrafiltration response to icodextrin.
Keyword Urology & Nephrology
Biological Transport
Glucose Polymer
High Transporter
Icodextrin
Peritoneal Dialysis Fluids
Peritoneum Physiology
Ultrafiltration Failure
Randomized Controlled-trial
Glucose Solutions
Transport
Fluid
Capd
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2006 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 15:39:03 EST