Possible applications of polyglucose (icodextrin) as a peritoneal dialysisfluid

Hyperosmolar glucose is the most frequently used peritoneal dialysis (PD) s olution, reaching the maximum of ultrafiltration capacity after 4-6 hrs dwe ll time. Due to a high peritoneal transport rate of small solutes, there is considerable glucose absorption into the circulation, leading to loss of t he osmotic driving force and subsequent loss of UF capacity, resulting in i mpaired ultrafiltration and fluid retention on one hand and hyperglycemia, hyperlipidemia, and overweight on the other. The glucose polymer icodextrin , a mixture of high molecular weight oligosaccharides of variable chain len gth ranging from 4-30 glucose units, represents an alternative option. The 7.5% solution is iso-osmolar with uremic serum and only small amounts are a bsorbed into the circulation. Ultrafiltration achieved by icodextrin, parti cularly during long dwell exchanges, is more efficient than that achieved b y glucose. The use of icodextrin reduces suppression of phagocyte function as well as formation of advanced glycation end products (AGEs) induced by h eat sterilization. As a consequence, there are several treatment options an d advantages of icodextrin: (a) in chronic UF failure, occuring after a pro longed period of time on peritoneal dialysis, icodextrin will extend PD tec hnique survival, (b) in high transporters long dwell exchanges can be used, e.g. in CAPD (continuous ambulatory PD) or during day time in CCPD (contin uous cyclic PD), (c) in acute peritonitis UF is maintained, and (d) in diab etes mellitus nocturnal glucose load is considerably reduced. In conclusion , use of icodextrin plays a significant role in optimizing treatment of PD patients.