Icodextrin instead of glucose during the daytime dwell in CCPD increases ultrafiltration and 24-h dialysate creatinine clearance

Background and methods. Icodextrin 7.5% is an isoosmolar, glucose polymer-containing peritoneal dialysis solution with an ultrafiltration potential similar to glucose 3.86%. We compared in an open, randomized, prospective study the ultrafiltration potential of icodextrin with that of glucose during the daytime dwell of 23 patients treated with automated peritoneal dialysis (CCPD). Results. Daytime ultrafiltration volume and 24-h ultrafiltration volume increased significantly in icodextrin-treated patients (n = 11) at 3 and 6 months, allowing patients a less rigid fluid restriction or an adapted treatment schedule. This improved the patients' subjective well-being. Although ultrafiltration at 9 and 12 months also increased it did not reach statistical significance. Similar to the gain in ultrafiltration volume, 24-h dialysate creatinine clearance per 1.73 m(2) (D-Cl/1.73 m(2)) and D-Cl/1.73 m(2) per litre used dialysate (D-Cl/1.73 m(2)/l) increased in icodextrin-treated patients. D-Cl/1.73 m(2)/l per litre ultrafiltrate (D-Cl/1.73 m(2)/l/UF) did not increase. No side-effects of icodextrin were encountered, although serum disaccharide levels increased. Conclusion. Icodextrin enhances ultrafiltration during the daytime dwell in CCPD patients. As a result of an increased 24-h ultrafiltration volume, D-Cl/1.73 m(2) and D-Cl/1.73 m(2)/l improve. D-Cl/1.73 m(2)/l/UF does not rise, which suggests that the increase in D-Cl/1.73 m(2) and D-Cl/1.73 m(2)/l is caused by convective transport.