Peritoneal kinetics and mesothelial markers in CCPD using icodextrin for daytime dwell for two years

Objective: To evaluate the safety, efficacy, and biocompatibility of icodex trin (Ico), continuous cycling peritoneal dialysis (CCPD) patients were tre ated for 2 years with either Ico- or glucose (Glu)-containing dialysis flui d for their daytime dwell (14-15 hours). Prior to entry into the study, all patients used standard Glu solutions (Dianeal, Baxter BV, Utrecht, The Net herlands). Design: Open, randomized, prospective two-center study. Setting: University hospital and teaching hospital. Patients: Both established patients and patients new to CCPD were included. A life expectancy of more than 2 years, a stable clinical condition, and w ritten informed consent were necessary before entry. Patients aged under 18 years or with peritonitis in the previous month, and women of childbearing potential unless taking adequate contraceptive precautions, were excluded. Thirty-eight patients entered the study (19 Glu, 19 Ico). Main Outcome Measures: Daytime dwell peritoneal effluents were collected ev ery 3 months in combination with other study Variables (clinical data, labo ratory measurements, dialysis-related data, and urine collection). Peritone al transport studies were carried out every 6 months. Results: in Glu- and Ico-treated patients, peritoneal transport of low mole cular weight solutes and protein clearances neither changed during follow-u p nor differed between the two groups. Peritoneal membrane markers (CA125, interleukin-8, carboxyterminal propeptide of type I procollagen, and aminot erminal propeptide of type III procollagen) measured in effluents did not d iffer between the groups and did not change over time. AII these markers sh owed a dialysate/plasma ratio of more than 1, suggesting local production. Residual renal function remained stable during follow-up and adverse clinic al effects were not observed. Conclusions: Peritoneal membrane transport kinetics and markers remained st able in both groups over a 2-year follow-up period. Membrane markers were h igher in effluents than in serum, suggesting local production. No clinical side effects were demonstrated. Icodextrin was a well-tolerated effective t reatment.