PERITONITIS OCCURRENCE IN A MULTICENTER STUDY OF ICODEXTRIN AND GLUCOSE IN CAPD

Objective:To compare peritonitis occurrence and outcome in a large U.K . study Multicentre Investigation of Icodextrin in Ambulatory Dialysis (MIDAS). Design: Prospective, randomized, controlled 6-month comparis on of icodextrin with glucose for the long dwell in continuous ambulat ory peritoneal dialysis (CAPD) patients. Setting: Eleven CAPD units in U.K. teaching hospitals. Patients: A total of 209 patients establishe d on CAPD for at least 3 months (103 control, 106 icodextrin). Twenty- three control (C) and 22 icodextrin (I) patients experienced peritonit is during the study. Intervention: Patients who had peritonitis remain ed on treatment (unless CAPD was withdrawn, temporarily or permanently ). Main Outcome Measures: The main outcome measures were the rate of p eritonitis and duration of CAPD treatment prestudy; the rate of perito nitis episodes and their outcome during study; the effect of peritonit is on laboratory variables, serum icodextrin metabolites, and ultrafil tration efficacy. Results: Prestudy: Nine (39%) of C but 14 (64%) of I patients had suffered previous peritonitis episode(s), with overall r ates of 0.58 and 0.78 episodes per patient-year, respectively. During study: Them were 31 C episodes and 35 I episodes, with overall rates o f 0.76 and 0.93 per patient-year, respectively. The increase in the C and I groups was 31% and 19%, respectively. Serum osmolality and sodiu m levels were unaffected by peritonitis, and there was no increase in serum icodextrin metabolites during peritonitis. Overnight ultrafiltra tion volume during peritonitis (mean+/-SD) declined slightly from 218/-354 mt to 185+/-299 mL(NS) in the control group, but increased in th e icodextrin group from 570+/-146 mt to 723+/-218 mt (p < 0.01). Concl usions: Using icodextrin for the long dwell in CAPD does not increase the rate of peritonitis, nor does it alter the outcome of peritonitis. Peritonitis does not affect uptake of icodextrin from the peritoneum.