An Exploratory Study of a Novel Peritoneal Combination Dialysate (1.36% Glucose/7.5% Icodextrin),Demonstrating Improved Ultrafiltration Compared to Either Component Studied Alone

Abstract

Objective

Concerns regarding the impact of ultrafiltration failure on peritoneal dialysis and the effect of hypertonic glucose on the peritoneal membrane have lead to a search for alternative dialysates. Computer simulations based on the three-pore theory suggest that a combination of 1.36% glucose and 7.5% icodextrin (glucose polymer) offers an improved ultrafiltration profile. The aim of the present study was to investigate the ultrafiltration profile of this combination fluid.

Design

Prospective open study comparing 1.36% glucose, 3.86% glucose, 7.5% icodextrin, and the combination fluid (1.36% glucose/7.5% icodextrin).

Setting

Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK.

Patients

11 patients currently using peritoneal dialysis not previously exposed to icodextrin.

Main Outcome Measure

Intraperitoneal volume was measured using a radioisotope dilution method.

Results

The combination fluid showed a biphasic ultrafiltration profile, with a steep initial increase in intraperitoneal volume, then a maintained plateau phase for the duration of the study dwell (7 hours). The final volume was greater than that with the 1.36% glucose dwell and the 7.5% icodextrin dwell. The fluid was well tolerated by the patients.

Conclusions

These findings are in keeping with computer simulations using the three-pore model. The combination fluid offers an improved ultrafiltration profile, with a final volume similar to 3.86% glucose, while avoiding exposing the peritoneal membrane to high glucose concentrations. It may have a role as a long dwell to optimize ultrafiltration and possibly prolong peritoneal dialysis technique survival.