Comparison of icodextrin and glucose solutions for the daytime dwell in automated peritoneal dialysis

Background. The sustained ultrafiltration achieved by icodextrin is more su ited for the daytime dwell in automated peritoneal dialysis (APD) than gluc ose solutions. Methods. Seventeen patients receiving APD underwent assessment using three different solutions for the daytime dwell: 2.27% glucose, 3.86% glucose and 7.5% icodextrin. Patients were then observed on icodextrin for a 6 month p eriod. Results. Daytime ultrafiltration was greater for 3.86% glucose (median 0.10 , IQR 0.01 to 0.321) P<0.01 and icodextrin (median 0.26, IQR 0.14 to 0.361) P<0.001 than 2.27% glucose (median -0.19, IQR -0.54 to -0.081), with 3.86% glucose and icodextrin not being significantly different. Positive ultrafi ltration occurred in 3/17 patients with 2.27% glucose, 13/17 patients with 3.86% glucose and 16/17 patients with icodextrin (chi(2) P<0.0001). The dif ference in ultrafiltration of icodextrin and 3.86% glucose correlated with the 4h dialysate/plasma creatinine ratio in a PET test (r= 0.51, P<0.05). D aytime Kt/V urea was greater for 3.86% glucose (median 0.27, IQR 0.20 to 0. 48 per week. P<0.01) and icodextrin (median 0.31, IQR 0.27 to 0.49 per week , P<0.0001) than for 2.27% glucose (median 0.22. IQR 0.15 to 0.38 per week) , with the difference between 3.86% glucose and icodextrin not reaching sta tistical significance (P=0.06). Daytime creatinine clearance was greater fo r 3.86% glucose (median 10.2, IQR 6.9 to 13.61/week/1.73 m(2), P<0.02) and icodextrin (median 12.1, IQR 9.3 to 15.71/week/1.73 m(2), P<0.005) than for 2.27% glucose (median 8.8, IQR 4.9 to 11.91/week/1.73 m(2)). Daytime creat inine clearance was greater for icodextrin than for 3.86% glucose (P<0.005) . The effects of icodextrin were sustained for the 6 month observation peri od. Conclusions. Icodextrin produced enhanced ultrafiltration and clearances co mpared with 2.27% glucose, without the exposure of the peritoncum to hypert onic glucose solutions.