Meta-analysis of Cohort Studies on Clinical Efficacy of Icodextrin Peritoneal Dialysate

Objective To evaluate the effect of real-world practices for icodextrin peritoneal dialysis solution on patients with end-stage renal disease(ESRD)by Meta-analysis.Methods The PubMed and Embase databases were systematically searched for real-world research literature on icodextrin peritoneal dialysate in the treatment of ESRD patients,and RevMan5.4 statistical software was used for Meta-analysis.Results and Conclusion 12 studies with 114656 patients were included.Meta-analysis results showed that icodextrin peritoneal dialysis had good effects on mortality[RR=0.72,95%CI(0.62,0.83),P<0.001],congestive heart failure[RR=0.67,95%CI(0.52,0.87),P=0.003],and risk of new-onset diabetes[RR=0.65,95%CI(0.49,0.86),P=0.003],which was consistent with the Meta-analysis based on clinical trials.Meanwhile,there was no significant difference in PD technical failure rate[RR=0.67,95%CI(0.44,1.00),P=0.05],peritonitis[RR=1.02,95%CI(0.99,1.05),P=0.14],cardiovascular and cerebrovascular diseases[RR=0.79,95%CI(0.59,1.05),P=0.10],coronary artery disease[RR=0.99,95%CI(0.92,1.07),P=0.80],stroke[RR=0.86,95%CI(0.66,1.10),P=0.23],and atrial fibrillation[RR=0.73,95%CI(0.37,1.44),P=0.36].However,it might increase the risk of hypertension[RR=1.05,95%CI(1.03,1.07),P<0.001].Therefore,icodextrin can effectively reduce the risk of mortality,congestive heart failure,and new-onset diabetes,which is beneficial to ESRD patients.

Peritoneal Membrane Transport Characteristics in Uni-PET with Preceding Icodextrin Dwell as Compared to Classic PET with Preceding Glucose Dwell: A Prospective Study

Background: In subjects on CAPD who use icodextrin for long night dwell, it has been recommended that nocturnal exchange be replaced by dextrose dwell whenever PET is to be performed as preceding exchange with icodextrin temporarily increases peritoneal membrane permeability and therefore, gives high D/PCr and low D/D0 glucose values. Whether this temporary change is also seen with use of Uni-PET (which involves one hour dwell of 1.5% dextrose followed by 4-hour dwell of 4.25% dextrose) is not known. Methods: In this self, controlled study, subjects on CAPD, who were using icodextrin for long nocturnal dwell for at least 3 months, were screened for enrolment. Pregnancy or lactation, history of any PD related infectious complication in the past one month, present or past malignancy, and poor functional status were exclusion criteria. Enrolled subjects underwent classic PET with preceding 2.5% dextrose long nocturnal dwell on day 1 followed by Uni-PET with preceding 7.5% icodextrin long nocturnal dwell on day 2. Difference in D/PCr and D/D0 glucose between the two PETs was primary objectives. The study was approved by Institute Ethics Committee. Results: 15 out of 26 screened subjects were enrolled over a period of 18 months (July 2015-December 2016). The mean (±SD) age of study population was 60.8±9.1 years. Majority were males and diabetes was the most common cause of CKD. Mean D/PCr were 0.68 ± 0.11 and 0.64 ± 0.08 in classic PET and Uni-PET, respectively. The difference between the two values was not significant [mean difference between D/PCr (classic PET-Uni-PET): 0.040 ± 0.86;95% CI (-0.007 to 0.088);p = 0.09]. Similarly, D/D0 glucose between classic PET and Uni-PET was also similar [mean difference between D/D0 glucose (classic PET-Uni-PET): -0.02 ± 0.09;95% CI (-0.06 to 0.03);p = 0.448]. Conclusion: Peritoneal membrane small solute transport characteristics in Uni-PET with preceding icodextrin dwell are similar to classic PET with preceding glucose dwell. If Uni-PET is used, it may not be necessary to replace preceding nocturnal exchange of icodextrin with that of dextrose as is currently advised.