Effect of Icodextrin Solution on the Preservation of Residual Renal Function in Peritoneal Dialysis Patients: A Randomized Controlled Study

Abstract

Although icodextrin solution has been highlighted in the fluid management compared to glucose-based solutions, proof of a beneficial effect of icodextrin solution on residual renal function (RRF) is lacking. We conducted a multicenter prospective randomized controlled open-label trial to investigate whether icodextrin solution can preserve RRF.One hundred patients with urine volume ≥750 mL/day from 8 centers in Korea were randomly assigned to receive 1 exchange of icodextrin solution for a ≥8 hour-dwell time and 2 exchanges of 1.5% glucose-based biocompatible neutral pH solution or 1 exchange of ≥2.5% and 2 exchanges of 1.5% glucose-based biocompatible solutions. Using mixed-effects general linear models, we analyzed changes in residual glomerular filtration rate (GFR) and daily urine volume at 1 year.Forty-nine patients were assigned to the icodextrin group and 51 to the glucose solution group. During follow-up, the slope of the decline in residual GFR was -0.170 mL/min/month/1.73 m² in the icodextrin group, while it was -0.155 mL/min/month/1.73 m² in the glucose solution group (95% confidence interval [CI], -0.06 to 0.10; P = 0.701). Daily urine volume decreased faster in the glucose solution group than in the icodextrin group (-31.02 vs -11.88 mL per month; 95% CI, -35.85 to -2.44; P = 0.025). Results were consistent when we analyzed using intention-to-treat and per protocol principles. There were no differences in fluid status, peritoneal ultrafiltration, and peritoneal transport between groups during follow-up.This study clearly showed that icodextrin solution preserves residual urine volume better than glucose solution.

FIGURE 1

Enrollment, randomization, and follow-up of study participants. PD = peritoneal dialysis, RRF = residual renal function.

FIGURE 2

Changes in residual glomerular filtration rates overtime between groups. (A) intention-to-treat analysis, (B) per-protocol analysis. Gray lines represent individual patient measurements, and solid and dash lines represent predicted slopes.

FIGURE 3

Changes in daily urine volume over time between groups. (A) intention-to-treat analysis, (B) per-protocol analysis. Gray lines represent individual patient measurements, and solid and dash lines represent predicted slopes.

FIGURE 4

Changes in fluid status such as left ventricular end-diastolic diameter (A), inferior vena cava collapsibility index (B), extracellular water/total body water ratio (C), and plasma atrial natriuretic peptide concentrations (D) overtime between groups. ECW = extracellular water, LVEDD = left ventricular end-diastolic diameter, IVC = inferior vena cava, TBW = total body water.