Effects of icodextrin in automated peritoneal dialysis on blood pressure and bioelectrical impedance analysis

Background. Glucose absorption from glucose-based dialysis fluids limits ul trafiltration from the daytime dwell in automated peritoneal dialysis (APD) . Icodextrin may allow greater ultrafiltration during the daytime period in APD, enhancing fluid control. Methods. A 7.5% icodextrin dialysate was compared with a 2.27% glucose dial ysate for the daytime dwell in 14 subjects on APD. Blood pressure, weight a nd body water compartments estimated by multifrequency bioelectrical impeda nce (MFBIA) were determined in subjects using 2.27% glucose as the daytime dwell and then repeated 1 month after switching to icodextrin. Results. Icodextrin resulted in symptomatic hypotension requiring reduction of antihypertensive medication in six of the 14 patients. Despite this red uction in treatment, systolic blood pressure fell from 142.4 (23.9) mmHg to 122.9 (17.7) mmHg, P<0.005, and diastolic blood pressure tended to fall fr om 82.8 (9.8) mmHg to 76.8 (10.1) mmHg, P = 0.075. Change in systolic blood pressure significantly correlated with changes in weight (r = 0.62, P<0.05 ) and MFBIA estimates of total body water (TBW) (r = 0.56, P<0.05), extrace llular water (ECW) (r = 0.79, P<0.002), extra/intracellular water ratio (EC W/ICW) (r = 0.72, P<0.01) and derived resistances R-ecf of ECW (r = -0.69, P<0.01) and R-inf of TBW (r = -0.66, P<0.02). Changes in diastolic blood pr essure significantly correlated with changes in ECW (r = 0.64, P<0.02) and ECW/ICW ratio (r = 0.58, P<0.05), and almost significantly with R-ecf (r = -0.51, P = 0.08) and R-inf (r = -0.52, P = 0.07) estimated by MFBIA, but no t with changes in weight or TBW. Conclusions. Use of icodextrin for the daytime dwell in APD results in impr oved fluid balance and blood pressure control compared with 2.27% glucose. MFBIA detected clinically important changes in fluid content in these patie nts.