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Randomized Controlled Trial of Icodextrin versus Glucose Containing Peritoneal Dialysis Fluid

Aiwu Lin^*, Jiaqi Qian^*, Xiaomei Li, Xueqing Yu, Wenhu Liu, Yang Sun^||, Nan Chen^¶, Changlin Mei^**, and for the Icodextrin National Multi-center Cooperation Group

^* Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai; Peking University First Hospital, Peking; The First Affiliated Hospital, Sun Yat-sen University, Guangzhou; Beijing Friendship Hospital, Capital Medical University, Peking; ^|| Peking Union Medical College Hospital, Peking; ^¶ Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai; and ^** Shanghai Changzheng Hospital, Shanghai, P.R. China

Correspondence: Dr. Jiaqi Qian,Renal Division, Renji Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Center for Peritoneal Dialysis Research, No. 145 Shan Dong Zhong Road, Shanghai 200001, P. R. China. Phone: 86-21-53882014; Fax: 86-21-63260745; E-mail: jiaqiqian{at}126.com

Background and objectives: While peritoneal dialysis with icodextrin is commonly used in patients with poor peritoneal membrane characteristics, the data on the usefulness of this solution in patients with lower transport characteristics are limited. The study was designed to compare icodextrin to glucose in Chinese prevalent peritoneal dialysis patients of different peritoneal transport characteristics (PET) categories.

Design, setting, participants, & measurements: This was a randomized, double-blind, perspective control study. Stable prevalent continuous ambulatory peritoneal dialysis (CAPD) patients were randomized to either 7.5% icodextrin (ICO) or 2.5% glucose (GLU) solution for 4 wk. Peritoneal membrane function was measured to define PET category in baseline. Creatinine clearance (Ccr), urea nitrogen clearance (C_BUN), ultrafiltration (UF) during the long night dwell, dialysate, and metabolic biomarkers were measured at baseline, 2, and 4 wk. UF, Ccr, and C_BUN were compared among different PET categories.

Results: A total of 201 CAPD patients were enrolled in the study. There were no baseline differences between the groups. Following 2 and 4 wk of therapy, Ccr, C_BUN, and UF were all significantly higher in the ICO versus the GLU group. Additionally, switching to ICO resulted in a significant increase in UF in high, high-average, and low-average transporters as compared with baseline. The extent of increased UF was more obvious in higher transporters. Blood cholesterol level in the ICO group decreased significantly than that in the GLU group.

Conclusion: Compared with glucose-based solution, 7.5% icodextrin significantly improved UF and small solute clearance, even in patients with low-average peritoneal transport.