Effect of icodextrin on volume status, blood pressure and echocardiographic parameters: A randomized study

• Published in: Kidney international Vol. 63; no. 4; pp. 1556 - 1563
• Main Authors: Konings, Constantijn J.A.M., Kooman, Jeroen P., Schonck, Marc, Gladziwa, Ulrich, Wirtz, Joris, Warmold van den Wall Bake, A., Gerlag, Paul G., Hoorntje, Steven J., Wolters, Johannes, Van Der Sande, Frank M., Leunissen, Karel M.L.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2003; Nature Publishing; Elsevier Limited
• Subjects: Adult; Aged; ambulatory blood pressure; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure; Blood Volume; Body Composition; Body Weight; Dialysis Solutions - administration & dosage; Diuresis; Echocardiography; Emergency and intensive care: renal failure. Dialysis management; Female; fluid state; Glomerular Filtration Rate; Glucans - administration & dosage; Glucose - administration & dosage; Humans; icodextrin; Intensive care medicine; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; peritoneal dialysis; Peritoneal Dialysis - methods; Peritoneum - metabolism; tracer dilution; Water-Electrolyte Balance; fluid state; peritoneal dialysis; ambulatory blood pressure; tracer dilution; icodextrin; echocardiography; Sonography; Kidney disease; Human; Icodextrin; Urinary system disease; Echocardiography; Dextrin; Exploration; Peritoneal dialysis; Extrarenal dialysis; Chemotherapy; Chronic; Treatment; Renal failure; Complication; Arterial pressure; Hemodynamics; Polysaccharide
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1046/j.1523-1755.2003.00887.x

Effect of icodextrin on volume status, blood pressure and echocardiographic parameters: A randomized study. Overhydration is a risk factor for hypertension and left ventricular hypertrophy in peritoneal dialysis patients. Recently, a high prevalence of subclinical overhydration was observed in peritoneal dialysis patients. Aim of the present open-label randomized study was to assess the effect of a icodextrin 7.5% solution on fluid status [extracellular water (ECW) bromide dilution], blood pressure regulation (24-hour ambulatory measurements) and echocardiographic parameters during a study period of 4 months, and to relate the effect to peritoneal membrane characteristics (dialysate/plasma creatinine ratio). Forty peritoneal dialysis patients (22 treated with icodextrin, 18 controls) were randomized to either treatment with icodextrin during the long dwell or standard glucose solutions. Thirty-two patients (19 treated with icodextrin, 13 controls] completed the study. The use of icodextrin resulted in a significant increase in daily ultrafiltration volume (744 ± 767 mL vs. 1670 ± 1038 mL; P = 0.012) and a decrease in ECW (17.5 ± 5.2 L vs. 15.8 ± 3.8 L; P = 0.035). Also the change in ECW between controls and patients treated with icodextrin was significant (-1.7 ± 3.3 L vs. +0.9 ± 2.2 L; P = 0.013). The effect of icodextrin on ECW was not related to peritoneal membrane characteristics, but significantly related to the fluid state of the patients (ECW:height) (r = -0.72; P < 0.0001). Left ventricular mass (LVM) decreased significantly in the icodextrin-treated group (241 ± 53 grams vs. 228 ± 42 grams; P = 0.03), but not in the control group. In this randomized open-label study, the use of icodextrin resulted in a significant reduction in ECW and LVM. The effect of icodextrin on ECW was not related to peritoneal membrane characteristics, but was related to the initial fluid state of the patient.