Effects of peritoneal dialysis with an overnight icodextrin dwell on parameters of glucose and lipid metabolism

. Objective: To examine whether a reduced daily glucose load by overnight a pplication of the less-absorbed glucose polymer icodextrin would have favor able effects on lipid profiles of continuous ambulatory peritoneal dialysis (CAPD) patients. . Study Design: Randomized crossover study with two subsequent periods of 6 weeks. . Setting: Home PD unit of a secondary-care hospital. .Patients: Twenty-one nondiabetic CAPD patients (15 male, 6 female; mean ag e 50.3 +/- 11.8 years). . intervention: Participants were randomly assigned to receive an overnight dwell with either standard glucose solution or wit h a 7.5% icodextrin-containing solution. .Main Outcome Measures: Relation between reduction in the total amount of i ntraperitoneal infused glucose and parameters of glucose (plasma glucose, i nsulin, and HbA(1C)) and lipid metabolism [free fatty acids, plasma lipids, lipoproteins, and low density lipoprotein (LDL) subfraction profile]. . Results: After the icodextrin dwells, a reduction of plasma total cholest erol (from 5.43 +/- 0.85 to 4.86 +/- 0.70 mmol/L, p< 0.001) and LDL cholest erol (from 3.38 +/- 0.87 to 2.93 +/- 0.73 mmol/L, p = 0.001) was observed. Also, high density lipoprotein (HDL) cholesterol (from 0.95 +/- 0.27 to 0.9 0 +/- 0.24 mmol/L, p = 0.029) was reduced, but the plasma total cholesterol -to-HDL ratio remained similar. Plasma free fatty acids and triglyceride le vels tended to decrease (from 0.16 +/- 0.10 to 0.13 +/- 0.08 mmol/L, p 0.06 , and from 2.14 +/- 1.96 to 1.92 +/- 1.03 mmol/L, respectively). Evaluation of LDL subfraction profiles after ultracentrifugation showed a more buoyan t LDL subfraction profile with fewer dense LDL particles in 6 patients and no changes in 14 patients after icodextrin. The effects on lipids were not accompanied by a decrease in fasting plasma glucose (from 5.76 +/- 1.29 to 5.86 +/- 0.80 mmol/L) or insulin levels (from 19.5 +/- 14.4 to 20.3 +/- 13. 0 mU/L). . Conclusion: These results suggest a beneficial effect on lipid profiles o f CAPD patients with the use of an overnight dwell with icodextrin.