ICODEXTRINS EFFECTS ON PERITONEAL TRANSPORT

Objective: To give a survey of the principles of peritoneal fluid tran sport in general, followed by an analysis of the effects of icodextrin on the transport of fluid and solutes. Design: A review of the litera ture and of data on the effects of icodextrin in continuous ambulatory peritoneal dialysis (CAPD) patients at the Academic Medical Center, A msterdam. Results: Icodextrin had no effect on the mass transfer area coefficients of low molecular weight solutes. Also no effect was found on the clearances of albumin and larger serum proteins. Due to convec tive transport, the clearance of beta(2)-microglobulin was greater wit h icodextrin than with glucose solutions. Icodextrin was especially su perior to glucose in the induction of net ultrafiltration during long dwells, during peritonitis, and in patients with ultrafiltration failu re caused by a large effective peritoneal surface area. Conclusion: Ic odextrin has no effect on the permeability characteristics of the peri toneal membrane, but increases convective flow through the small-pore system. As a result, the peritoneal clearance of beta(2)-microglobulin is higher than with glucose-based solutions. Icodextrin is especially indicated for long dwells and in patients with impaired ultrafiltrati on caused by a large peritoneal surface area, leading to high transpor t rates of low molecular weight solutes.