Benefits of a continuous ambulatory peritoneal dialysis (CAPD) technique with one icodextrin-containing and two biocompatible glucose-containing dialysates for preservation of residual renal function and biocompatibility in incident CAPD patients

Abstract

In a prospective randomized controlled study, the efficacy and safety of a continuous ambulatory peritoneal dialysis (CAPD) technique has been evaluated using one icodextrin-containing and two glucose-containing dialysates a day. Eighty incident CAPD patients were randomized to two groups; GLU group continuously using four glucose-containing dialysates (n=39) and ICO group using one icodextrin-containing and two glucose-containing dialysates (n=41). Variables related to residual renal function (RRF), metabolic and fluid control, dialysis adequacy, and dialysate effluent cancer antigen 125 (CA125) and interleukin 6 (IL-6) levels were measured. The GLU group showed a significant decrease in mean renal urea and creatinine clearance (-Δ1.2 ± 2.9 mL/min/1.73 m(2), P=0.027) and urine volume (-Δ363.6 ± 543.0 mL/day, P=0.001) during 12 months, but the ICO group did not (-Δ0.5 ± 2.7 mL/min/1.73 m(2), P=0.266; -Δ108.6 ± 543.3 mL/day, P=0.246). Peritoneal glucose absorption and dialysate calorie load were significantly lower in the ICO group than the GLU group. The dialysate CA125 and IL-6 levels were significantly higher in the ICO group than the GLU group. Dialysis adequacy, β2-microglobulin clearance and blood pressure did not differ between the two groups. The CAPD technique using one icodextrin-containing and two glucose-containing dialysates tends to better preserve RRF and is more biocompatible, with similar dialysis adequacy compared to that using four glucose-containing dialysates in incident CAPD patients. [Clincal Trial Registry, ISRCTN23727549].

Keywords: Biocompatibility; Icodextrin, Randomized Controlled Trial; Peritoneal Dialysis, Continuous Ambulatory; Residual Renal Function.

Fig. 1

Enrollment, randomization and follow-up of patients. HD, hemodialysis; APD, automated peritoneal dialysis.

Fig. 2

Change in mean of renal urea and creatinine clearance (renal CrCl) and daily urine volume. (A) The renal CrCl significantly decreased at 12 month in the GLU group (open circles), but not in the ICO group (closed circles). (B) The daily urine volume significantly decreased at 6 month and 12 month in the GLU group (open circles), but not in the ICO group (closed circles). The urine volume was significantly higher in the ICO group than the GLU group at 12 month. Data are means±SEM. ^*P values were analyzed by unpaired Student's t-test; ^†P values were analyzed by mixed model; ^‡P values were analyzed by paired t-test; ^§P values were analyzed by repeated measures ANOVA.

Fig. 3

Change in peritoneal glucose absorption and dialysate calorie load. (A) Peritoneal glucose absorption was significantly lower in the ICO group than the GLU group at 6 month and 12 month. While the peritoneal glucose absorption significantly increased in the GLU group (open circles) at 12 month, it significantly decreased in the ICO group (closed circles) at 6 month and 12 month compared with 0 month. (B) The dialysate calorie load was significantly lower in the ICO group than the GLU group at 6 month and 12 month. While the dialysate calorie load significantly increased in the GLU group (open circles) at 12 month, it significantly decreased in the ICO group (closed circles) at 6 month compared with 0 month. ^*P values were analyzed by unpaired Student's t-test; ^†P values are analyzed by paired t-test; ^‡P values were analyzed by repeated measures ANOVA.

Fig. 4

Change in peritoneal effluent CA125 and IL-6 levels. (A) The peritoneal effluent CA125 levels were significantly higher in the ICO group than the GLU group at 6 month and 12 month. In contrast to the GLU group (open circles), the ICO group (closed circles) showed a significant increase in effluent CA125 levels at 6 month and 12 month compared with 0 month. (B) The dialysate IL-6 level was significantly higher in the ICO group than the GLU group at 6 month and 12 month. While the effluent IL-6 levels did not change in the GLU group (open circles), it significantly increased in the ICO group (closed circles) at 6 month and 12 month compared with 0 month. Data are means±SEM. ^*P values were analyzed by unpaired Student's t-test; ^†P values were analyzed by paired t-test; ^‡P values were analyzed by repeated measures ANOVA.