Icodextrin Improves the Fluid Status of Peritoneal Dialysis Patients: Results of a Double-Blind Randomized Controlled Trial

Worsening fluid balance results in reduced technique and patient survival in peritoneal dialysis. Under these condi- tions, the glucose polymer icodextrin is known to enhance ultrafiltration in the long dwell. A multicenter, randomized, double-blind, controlled trial was undertaken to compare ico- dextrin versus 2.27% glucose to establish whether icodextrin improves fluid status. Fifty patients with urine output 750 ml/d, high solute transport, and either treated hypertension or untreated BP 140/90 mmHg, or a requirement for the equiv- alent of all 2.27% glucose exchanges, were randomized 1:1 and evaluated at 1, 3, and 6 mo. Members of the icodextrin group lost weight, whereas the control group gained weight. Similar differences in total body water were observed, largely ex- plained by reduced extracellular fluid volume in those receiv- ing icodextrin, who also achieved better ultrafiltration and total sodium losses at 3 mo (P 0.05) and had better maintenance of urine volume at 6 mo (P 0.039). In patients fulfilling the study's inclusion criteria, the use of icodextrin, when compared with 2.27% glucose, in the long exchange improves fluid removal and status in peritoneal dialysis. This effect is appar- ent within 1 mo of commencement and was sustained for 6 mo without harmful effects on residual renal function.