Analysis of ultrafiltration volume during long dwell with icodextrin in automated peritoneal dialysis

Icodextrin's unique osmotic properties enable effective fluid volume management in the peritoneal cavity by limiting reabsorption. However, its efficacy fluctuates during prolonged dwell periods in automated peritoneal dialysis (APD), posing challenges and increasing the risk of treatment failure. This study examines negative ultrafiltration (UF) during daytime dwell in APD patients using icodextrin and aims to identify associated factors. A retrospective observational monocentric study on UF during prolonged icodextrin dwell periods in APD was conducted among 27 incident patients at the University Hospital of Caen in Normandy, France. The primary focus was the presence of negative daytime UF, with intraperitoneal pressure (IPP) as the main exposure variable. Statistical analyses, including group comparisons and univariate and multivariate logistic regressions, explored associations between negative daytime UF, IPP, and other relevant variables. While no variable showed a significant correlation, IPP (OR=1.06), Volume of the last injection (OR=0.97), and Body Mass Index (OR=0.97) exhibited interesting trends. The multivariate analysis showed no significant association between the variables and negative daytime UF. Nevertheless, IPP was the only variable that improved the model's quality, suggesting a potential link for further exploration. This study raises important questions for future research and clinical practice regarding the systematic measure of the IPP during peritoneal dialysis treatments, despite its limitations, including a small sample size and the retrospective observational nature of the methodology, affecting the statistical power and the ability to establish causal links.