Effect of Icodextrin on Volume and Metabolism: A Multicenter Clinical Study

Background: Icodextrin is a novel peritoneal dialysis fluid that enhances fluid clearance. It works through the formation of colloidal osmotic pressure, so it maintains effective ultrafiltration for a longer period of time, and the incidence of ultrafiltration (UF) failure is much lower than that of glucose peritoneal dialysis solution.The aim of this study was to compare the changes in volume and metabolism of patients before and after icodextrin treatment, expecting more evidence to support the effectiveness of icodextrin. Methods: After screening for inclusion and exclusion criteria, we included 20 cases of continuous ambulatory peritoneal dialysis (CAPD) patients from seven hospitals of Yunnan Province.These patients were given a 3-month long-stay nocturnal treatment with icodextrin .We compared nocturnal net UF, peritoneal creatinine clearance( Ccr), and body weight, BNP. And related metabolic parameters, including fasting blood glucose(FBG), cholesterol(TC), and triglycerides(TG), before and after icodextrin treatment. Results: After 3 months of treatment with icodextrin, patients showed significant increase in nocturnal long-stay abdominal net UF and peritoneal Ccr. The mean nocturnal long-stay net abdominal UF was (57.78±257.63) ml at baseline and (681.85±168.23) ml after treatment (difference -624.07, 95% CI -742.69 －-505.45, t=-11.10, P<0.001). The patient's peritoneal Ccr was (2.10±0.40) ml/min at baseline and (3.10±0.48) ml/min after treatment (difference -1.00, 95% CI -1.31－0.68, t=-6.72, P<0.001). Pre-treatment weight (64.98±10.79) kg Post-treatment weight (63.09±10.28) kg, (difference 1.89, 95% CI 0.58－3.21, t=3.05, P=0.007). After treatment, the patients' BNP decreased, but the difference was not statistically significant (P>0.05); FBG, TG and TC increased afterward, but the mean values were still in the normal range, and the difference was not statistically significant (P>0.05). Conclusion: In this study, icodextrin was found to increase UF and peritoneal Ccr as well as improve volume control in patients. It can remove more water and reduce patients' body weight.But no significant effect of icodextrin in improving glycolipid metabolism and lowering BNP has been detected for the time being, and the effect of icodextrin on cardiac function needs to be further explored, and its long-term effects and potential application in specific patient groups need to be further investigated. Funding: Government Support – Non-U.S.